MOTOR  RETARDATION  AS  A MANIC-DEPRESSIVE 

SYMPTOM. 


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MOTOR  R1 


By  FREDERIC  LYMAN  WELLS,  Ph.  D., 

Assistant  in  Pathological  Psychology  in  the  McLean  Hospital, 
Waver  ley,  Mass. 


Reprinted  from 

AMERICAN  JOURNAL  OF  INSANITY 
Vol.  LXVI,  No.  1,  July,  1909 


4 


Volume  LXVI 


JULY,  1909 


No. 


AMERICAN 

JOURNAL  OF  INSANITY 


MOTOR  RETARDATION  AS  A MANIC-DEPRESSIVE 

SYMPTOM. 

By  FREDERIC  LYMAN  WELLS,  Ph.  D, 

Assistant  in  Pathological  Psychology  in  the  McLean  Hospital, 
Waver  ley,  Mass. 

CONTENTS. 

PAGE 


1.  The  Experimental  Criterion  of  Retardation i 

2.  Clinical  Histories  and  Experimental  Results 13 

3.  General  Conclusions  46 


I.  The  Experimental  Criterion  of  Retardation. 

Our  reaction  to  a given  situation  is  determined  by  the  lines  of 
least  resistance  in  the  nervous  pathways  at  that  moment  and  to 
that  stimulus.  This  “ set  of  the  nervous  system  is  determined 
essentially  by  the  various  impulses  that  have  traversed  it  before, 
and  by  immediate  conditions  of  nutrition.  These  factors  give  a 
series  of  lines  of  least  resistance  to  an  indefinite  number  of  situa- 
tions, and  the  reaction  to  any  of  these  situations  will  be  along  the 
line  of  least  resistance  which  the  past  history  of  the  individual 
has  determined  for  it.  The  factors  which  go  to  determine  these 
lines  of  least  resistance  are  normally  and  naturally  selected  in 
such  a way  as  shall  be  most  beneficial  to  their  possessor.  It  is 
apparent  how  largely  the  teleological  character  of  our  behavior 
depends  upon  the  maintenance  of  the  fine  balance  in  the  nervous 
pathways  in  favor  of  the  most  advantageous  series  of  responses. 
One  can  also  readily  figure  the  profound  disorder  of  behavior 
inevitably  resulting  from  any  disturbances  of  this  neural  bal- 
ance,” be  these  disturbances  themselves  the  ultimate  products  of 
intoxication,  or  of  faulty  habits  of  action  and  thought. 


I 


2 MOTOR  RETAEiDATION  [July 

In  a fundamental  retardation  we  have  an  agency  or  number 
of  agencies,  presumably  of  toxic  origin,  which  tend  to  increase 
the  difficulty  with  which  certain  nervous  impulses,  consequently 
certain  psychic  functions,  can  proceed.  The  actual  study  of 
cases  shows  us  that  the  symptom  of  retardation  may  involve 
the  various  mental  functions  largely  independently  of  one  another. 
When  its  manifestations  occur  mainly  in  the  higher,  associative 
processes  of  the  mind,  we  speak  of  it  as  a ‘‘  difficulty  in  thinking  ” 
or  “ thinking  disorder  ’’ ; we  may  also  see  its  phenomena  confined 
with  some  definiteness  to  the  motor  side;  and  as  has  been  else- 
where suggested,  those  manic-depressive  states  which  show  an 
emotional  condition  of  apparent  apathy  in  contradistinction  to 
depression  are  the  manifestation  of  this  same  symptom  in  the 
afifective  sphere.  In  like  manner  we  may  find  these  phenomena 
even  more  restricted  within  the  categories  mentioned. 

It  is  obvious,  however,  that  in  merely  speaking  of  a “ greater 
difficulty  ” of  the  nervous  processes,  we  do  not  tell  the  whole 
story  of  the  effect  of  this  difficulty  upon  the  resulting  movements, 
which  are,  of  course,  our  ultimate  criteria  of  the  symptom.  The 
response  may  be  merely  delayed,  without  seeming  to  be  otherwise 
affected.  More  often,  however,  there  is  coupled  with  this  delay 
a certain  weakening  of  its  force  and  effectiveness.  On  the  other 
hand,  the  response  may  be  long  delayed  and  then  come  with 
explosive  force,  as  though  the  patient  had  been  gradually  accumu- 
lating sufficient  energy  to  burst  through  the  retardation.  Occa- 
sionally the  response  fails  entirely,  apparently  from  not  being 
strong  enough  to  break  through ; this  is  apt  to  be  the  case  with 
indifferent  situations.  Under  great  stresses,  however,  a marked 
retardation  may  be  entirely  swept  away,  indicating  a considerable 
reserve  strength  of  the  voluntary  impulse,  just  as  our  muscles 
seldom  if  ever  put  forth  under  voluntary  stimulation  the  effort 
of  which  they  are  physiologically  capable. 

Clinically,  we  judge  of  a patient’s  retardation  through  the  gen- 
eral character  of  his  behavior,  by  the  quickness  with  which  he 
seems  to  think  or  speak  or  move.  Experimentally,  we  make  use 
of  the  innumerable  tests  put  forward  as  measures  of  mental  time. 
So  long  as  we  deal  only  with  the  presence  or  absence  of  retarda- 
tion in  general,  the  precise  mental  function  that  we  sdect  to 
measure  is  probably  of  secondary  importance  to  the  accuracy  of 


FREDERIC  LYMAN  WELLS 


3 


5L 

\aJ4G 


1909] 

the  experimental  method  itself.  Most  such  experiments,  however, 
would  afford  very  little  information  about  the  character  of  the 
retardation,  whether  concerned  with  the  lower,  motor,  or  higher, 
associative  processes.  A purely  intellectual  retardation  we  cannot 
measure  directly  by  any  psychological  methods  at  present  known, 
for  we  always  require  some  form  of  motor  response  in  addition 
to  the  intellectual  or  associative  process.  We  may  first  turn 
attention  therefore  to  the  functions  which  are  more  primarily 
motor,  attempting  to  make  our  measure  of  retardation,  so  far  as 
possible,  independent  of  the  higher  mental  processes. 

To  experimentally  isolate  mental  retardation  from  motor  re- 
tardation is  no  easy  task.  Almost  every  experiment  in  the  time 
relations  of  voluntary  movement  involves  a conscious  process  of 
greater  or  less  complexity,  followed  by  a motor  response.  While 
this  is  not  absolutely  true  (as  in  simple  reaction  time  in  late  prac- 
tice) it  is  essentially  so  in  the  situations  with  which  we  have  to 
deal  clinically.  For  rough  and  ready  purposes,  some  idea  can  be 
gained  from  the  comparative  degrees  of  retardation  in  responses 
involving  different  degrees  of  purely  mental  effort.  Thus  if  a 
subject  could  calculate  but  slowly,  and  yet  could  respond  quickly 
to  commands,  the  indication  would  be  that  the  retardation  was 
mainly  in  the  nature  of  a thinking  disorder.  On  the  other  hand, 
the  more  the  simple  and  complex  responses  were  equal  in  slow- 
ness, the  greater  the  likelihood  of  a retardation  principally  in  the 
lower,  motor  centres.  The  presence  of  a certain  amount  of 
ordinary  motor  activity  does  not  prove  the  absence  of  a motor 
retardation.  The  essential  point  here  would  be  whether  the 
reactive  movements  are  quick  or  slow,  and  this  does  not  appear 
in  the  ordinary  observation  of  a patient’s  behavior.  The  phe- 
nomena which  seem  to  be  associated  with  motor  retardation  in 
these  experiments  have  appeared  most  strikingly  in  cases  in 
which  little  if  any  retardation  would  have  been  evident  to  ordinary 
clinical  examination. 

But,  as  has  been  said,  the  time  of  reaction  in  most  psycho- 
logical experiments  is  an  unsatisfactory  measure,  since  there  is 
not  sufficient  differentiation  between  the  mental  and  motor  aspects 
of  the  symptom.  Even  such  a measure  as  simple  reaction  to  sound 
is,  at  all  ordinary  stages  of  practice,  seriously  vitiated  by  this 
difficulty  in  interpretation.  Obviously,  the  simpler  and  more  in- 


4 


MOTOR  RETARDATION 


[July 


dependent  of  the  higher  centres  we  make  our  experimental  proc- 
ess, the  more  exclusively  it  becomes  concerned  with  the  purely 
motor  factors,  and  a measure  of  time  relations  in  the  motor  sphere. 

Of  those  reactions  to  external  situations  which  are  so  automatic 
as  to  be  largely  independent  of  control  of  the  higher  centres,  the 
eye  movements  are  the  most  important.  Theoretically,  I should 
consider  the  ocular  pursuit  reaction  (Diefendorf  and  Dodge)  as 
altogether  the  best  criterion  of  retardation  by  the  method  of 
reaction  to  external  stimulus.  The  present  criterion  of  retarda- 
tion possesses  a good  quality  in  that  it  is  not  immediately  depend- 
ent on  reaction  to  external  stimulus,  as  well  as  certain  minor 
technical  advantages. 

The  psychological  process  involved  in  the  successive  movements 
of  the  tapping  test  is  not  clearly  made  out.  It  is,  however,  the 
verdict  of  introspection  that  the  successive  taps  at  maximum  rate 
are  not  each  the  product  of  a separate  conscious  innervation.  Nor 
can  we  conceive  of  the  process  as  one  of  successive  simple  re- 
actions to  the  various  kinsesthetic  sensations  that  the  movements 
of  the  test  present.  The  normal  initial  rate  of  tapping  (about  7 
per  second)  cannot  be  executed  without  14  co-ordinated  move- 
ments per  second,  and  in  reality  the  process  is  much  more  com- 
plex. Only  the  simplest  reflexes  have  such  a rate  as  this ; no 
movement  in  which  a voluntary  process  shares.  A series  of  taps 
at  the  maximum  rate  is  therefore  a product  of  but  few  volitional 
processes,  which  merely  give  a ‘‘  set  ” to  which  the  organism 
responds  by  a continued  series  of  reflex  responses. 

What  then  determines  the  rate  at  which  these  reflex  responses 
take  place?  It  is  limited  by  the  refractory  phase  of  the  neurone- 
paths,  but,  save  in  late  practice,  it  is  much  slower  than  this ; it  is 
a matter  mainly  of  efficiency  in  co-ordination.  Beyond  this  we 
must  judge  purely  empirically,  by  noting  the  external  conditions 
which  affect  it.  In  normal  individuals  it  does  not  seem  to  be 
especially  influenced  by  conditions  which  are  open  to  introspection. 
On  the  other  hand,  any  previous  activities  tending  to  produce 
the  Erregung”  of  Kraepelin,  seem  to  increase  the  rate.  If  car- 
ried to  the  point  of  physical  fatigue,  the  rate  is  decreased ; but  it 
does  not  seem  that  what  is  ordinarily  called  “ intellectual  fatigue  ” 
has  any  marked  effect.  If  the  tapping  be  continued,  there  results 
the  decrease  in  efficiency  ordinarily  described  as  fatigue.  This 


1909] 


FREDERIC  LYMAN  WELLS 


5 


can  hardly  be  dependent  on  muscular  factors,  since  it  normally 
is  a matter  of  about  14  per  cent  within  180  taps,  and  the  isolated 
muscle  would  hardly  fatigue  to  rapidly  succeeding  stimuli  in  this 
way.  Nor  has  it  any  but  a very  indirect  relation  to  the  sensa- 
tions of  fatigue,  which  are  presumably  of  muscular  origin.  The 
process  can  only  be  described  as  a decreased  efficiency  of  co- 
ordination (possibly  also  to  a proportionate  lengthening  of  the 
period  of  the  refractory  phase).  Both  the  absolute  rate  and  the 
fatigue  phenomena  of  the  tapping  test  seem  thus  to  be  determined 
by  obscure  conditions  of  neural  tone. 

Once  the  general  volition  to  tap  as  rapidly  as  possible  is  ob- 
tained, the  minute  features  of  the  process  go  on  in  relative  inde- 
pendence of  conscious  influence;  it  is  not  therefore  a function 
that  we  should  expect  to  see  especially  influenced  in  the  presence 
of  a pure  thinking  disorder.  This  might  affect  the  time  taken 
to  respond  to  the  signal  to  begin  to  tap ; but  once  the  tapping  is 
begun,  its  rate  is  rather  a matter  of  raised  or  lowered  Willen's- 
spannung,  using  this  term  in  a wholly  objective  sense. 

The  efficiency  of  this  purely  motor  responsiveness  of  the  or- 
ganism, the  maximum  rate  of  repeated  voluntary  movements 
measures  in  a relatively  unequivocal  way.  For  the  rest,  it  is  an 
ordinary  work-curve,  such  as  may  be  obtained  in  any  continuous 
psychological  experiment,  being  subject  to  and  reflecting  all  the 
influences  which  affect  the  curve  of  work.  Fatigue,  and  the 
reflex  inhibitions  resulting  from  sensations  of  fatigue,  tend  to 
produce  a decrease  in  efficiency.  Factors  having  a favorable  in- 
fluence are  the  so-called  “ warming  up  ” processes,  as  well  as  any 
more  or  less  external  influences  that  may  spur  the  organism  to 
greater  effort.  The  work-curve  that  we  finally  obtain  is  the  com- 
plex of  all  such  influences,  and  their  separate  analysis  is  impossible 
save  on  a purely  empirical  basis.  We  are  not  concerned,  however, 
with  the  measurement  of  such  abstractions  as  absolute  fatigue, 
warming  up,  or  impulse  effects,  but  with  the  immediate  question 
of  how  the  individual  responds  to  any  experimental  conditions 
demanding  the  continual  exercise  of  a certain  voluntary  effort. 
In  every  individual  and  in  every  measure  the  factors  that  determine 
the  course  of  the  Arheitskurve  have  a certain  way  of  balancing 
each  other,  and  the  way  in  which  this  balance  varies  in  different 


6 


MOTOR  RETARDATION 


[July 


individuals  and  under  different  conditions  is  the  essence  ot  the 
problem  with  which  we  are  attempting-  to  deal. 

In  a previous  report,  attention  was  called  to  certain  anomalies 
in  the  work-curve  especially  associated  with  the  retardation  of 
manic-depressive  depression.^  In  the  present  study  certain  of  the 
more  important  of  these  cases,  together  with  certain  additional  ma- 
terial, will  be  more  fully  presented  from  the  standpoint  of  clinical 
analysis,  and  the  correlation  of  the  experimental  results  with  the 
clinical  pictures.  Certain  points  in  differential  symptomatology 
also  appear. 

While  the  method  and  general  experimental  conditions  are  the 
same  as  those  described  in  a previous  contribution,^  a brief  review 
of  them  may  not  be  out  of  place  here.  The  subject  begins  at  a 
given  signal  and  taps  at  the  maximum  rate  until  a record  of  30 
seconds  is  obtained,  when  he  receives  a signal  to  stop.  Then 
follows  a 2-minute  and  30-second  pause,  after  which  a second 
series  is  executed,  then  another  2-minute  and  30-second  pause, 
and  so  on  until  five  series  of  30  seconds,  each  with  an  intervening 
pause  of  2 minutes  and  30  seconds,  have  been  obtained.  A sim- 
ilar record  of  five  30-second  series  is  then  made  with  the  other 
hand.  When  more  than  one  experiment  is  made,  the  hands 
alternate  in  precedence  from  experiment  to  experiment,  except 
as  otherwise  specified.  In  this  form  the  experiment  requires 
about  half  an  hour  to  make,  the  greater  part  of  which  time  is 
occupied  in  the  pauses.  This  time  can,  of  course,  be  much  short- 
ened by  having  the  hands  alternate  from  series  to  series,  with 
a very  much  shorter  pause,  say  30  seconds,  intervening  between 
the  different  hands.  For  the  first  five  or  six  daily  experiments 
(50  or  60  series)  the  writer  does  not  believe  that  this  shorter 
form  would,  in  normal  subjects,  yield  different  results  from  the 
form  with  the  2-minute  and  30-second  pause.  In  the  present 
subjects,  however,  many  of  the  points  which  appear  of  essential 
significance  would  have  been  much  obscured  by  such  a routine, 
so  that  this  apparently  uneconomical  form  of  experiment  seems 
to  have  more  than  justified  itself. 

The  experiment  is  evaluated  by  counting  the  number  of  times 

^ Studies  in  Retardation,  Am.  J.  Psych.,  XX,  1909,  pp.  38-59. 

* Am.  J.  Psych.,  XIX,  1908,  pp.  437-439- 


1909] 


FREX>ERIC  LYMAN  WELLS 


7 


the  key  is  struck  and  the  circuit  closed  during  each  of  the  six 
5-second  intervals  in  each  30  seconds’  tapping.  The  precise 
method  of  dealing  with  the  data  may  be  illustrated  by  quoting 
in  full  the  figures  of  a single  record  (five  series)  with  the  right 
hand  of  a normal  individual  at  the  beginning  of  practice. 

TYPE  RECORD. 


I I I ®l 

I I J ^ . 


Ist  interval  0' 

2d  interval  6" 

3d  interval  10" 

4th  Interval  15' 

6th  interval  20' 

6th  interval  26' 

Total  numbe 

taps  in  eaol 

series. 

ist  Series  

.35 

34 

32 

33 

32 

32 

198 

2d  Series  

.36 

33 

33 

33 

31 

31 

197 

3d  Series  

.36 

34 

34 

32 

32 

33 

201 

4th  Series  

.36 

34 

34 

33 

34 

33 

204 

5th  Series  

.38 

38 

36 

35 

34 

34 

215 

Average  of  intervals. 

.36.2 

34-6 

33-8 

33-2 

32.6 

32.6 

203.0 

Each  of  the  30  two-place  integers  gives  the  number  of  taps 
executed  in  an  interval  of  5 seconds.  Reading  the  top  line 
from  left  to  right,  we  obtain  a gradual  decrease  in  the  size  of 
the  figures,  indicating  a slowing  up  in  the  tapping  rate.  The 
rig:ht  hand  figure  of  three  digits,  198,  gives  the  sum  of  the  figures 
for  the  six  intervals,  i.  e.,  the  number  of  taps  for  the  whole  30 
seconds.  Each  successive  line  may  be  read  in  the  same  way. 
Considering  the  two-place  integers  in  column,  we  obtain  in  the 
six  figures  of  two  digits  and  a decimal  on  the  bottom  line  (36.2, 
34.6,  33.8,  33.2,  32.6,  32.6)  the  average  number  of  taps  executed 
during  the  first  5 seconds,  the  second  5 seconds,  etc.  Naturally, 
a regular  decrease  is  noted.  The  figure  in  heavy-faced  type, 
203.0,  gives  the  sum  of  these  six  interval  figures,  i.  e.,  the  average 
number  of  taps  executed  each  time  during  the  five  30-second 
series.  This  figure  is  taken  as  indicating  the  “ total  efficiency  ” 
of  the  function  in  that  record,  subject,  of  course,  to  the  variability 
of  the  single  series  it  represents.  Six  successive  5-second  intervals 
form  a series,  five  30-second  series  a record,  and  the  two  records 
of  right  and  left  hands  constitute  the  single  standard  experiment. 


8 


MOTOR  RETARDATION 


[July 


An  index  of  fatigue  (f)  for  each  record  is  obtained  by  dividing 
the  average  of  the  last  five  intervals  by  the  average  for  the  first 
interval.  The  average  for  first  interval  is  36.2,  and  the  average 

for  the  remaining  five  is  33.6 ; the  therefore,  equals  33;^^  or  .93. 

36.2 

A high  f indicates  immunity  to  fatigue  loss,  a low  f indicates 
susceptibility  to  it.  If  the  f is  above  i.oo  it  indicates  that  the 
favorable  influences  on  the  work-curve  so  outweigh  those  of 
fatigue  that  the  performance  of  the  five  later  intervals  averaged 
actually  better  than  the  first  interval.  In  normal  individuals 


jVo.  oj  fd-ps  IT]  5^ 


5‘'  /o"  /5'  20^  25" 

Fig.  I. 

this  practically  never  occurs ; the  normal  f tends  to  fluctuate 
between  .85  and  .95. 

There  are,  of  course,  many  other  features  in  the  experiment, 
but  in  the  present  paper  we  shall  be  mainly  concerned  with  this 
/,  and  with  the  character  of  the  work-curve,  of  which  it  is  an 
index.  The  fatigue-curve  is  plotted  by  joining  together  the  points 
representing  the  average  of  five  performances  during  each  5- 
second  interval ; thus  the  curve  in  the  above-quoted  record  would 
run  as  shown  in  Fig.  i. 

This  gives,  in  each  complete  experiment,  a curve  for  the  right 
and  a curve  for  the  left  hand.  With  normal  subjects  two  experi- 


FREDERIC  LYMAN  WELLS 


9 


1909] 

ments  are  described,  the  work  with  the  right  hand  preceding  in 
the  first  experiment,  and  that  with  the  left  hand  preceding  in 
the  second  experiment.  In  speaking  further  of  these  records, 

X 


- 10"  is"  ZO*  0.5"  do" 

Fig.  2. 

Ri  and  Li  will  be  used  to  designate  those  of  the  right  and  left 
hands  in  the  first  experiment;  R2  and  L2  the  right  and  left 
hands  in  the  second  experiment.  Where  a greater  number  of 


lO 


MOTOR  RETARDATION 


[July 


experiments  are  performed,  the  hands  alternate  in  precedence 
from  experiment  to  experiment.  As  it  makes  some  difference 
which  hand  comes  first,  it  is  necessary  to  distinguish  these  ex- 
periments in  the  curves.  The  experiments  in  which  the  right 
hand  precedes  are  sketched  in  a continuous  line,  those  in  which 
the  left  hand  precedes  are  sketched  in  a broken  line.  The  upper 
continuous  and  dotted  lines  naturally  refer  to  the  right  hand, 
the  lower  to  the  left  hand,  except  as  otherwise  specially  indicated. 
According  to  this  scheme  of  presentation,  the  course  of  the 
fatigue  phenomena  was  found  in  lo  normal  men  to  be  as  shown 
in  Fig.  2.* 

That  is,  the  curves  follow  the  usual  form,  the  decrease  in  the 
rapidity  of  tapping  being  more  rapid  in  the  earlier  intervals,  and 
then  slower.  The  f,  or  ratio  of  the  last  five  intervals  to  the  first, 
approximates  .90  in  each  case,  being  a little  higher  in  the  right 
than  in  the  left.  We  see  that  the  hands  are  somewhat  closer 
together  in  the  second  experiment  than  in  the  first,  that  is,  the 
right  hand  is  relatively  better  in  the  first  experiments  and  the 
left  hand  better  in  the  second.  Each  hand  thus  tends  normally 
to  be  relatively  better  when  it  precedes  than  when  it  follows  in 
the  experiment.  This  relationship  is  markedly  disturbed  in  some 
pathological  cases,  sometimes  so  much  so  that  whichever  hand 
precedes,  it  is  always  better  (or  worse)  than  the  following  hand. 

In  a typically  retarded  case  of  manic-depressive  depression 
the  curves  shown  in  Fig.  3 were  obtained. 

These  curves  will  serve  to  illustrate  most  of  the  peculiarities 
found  in  the  records  of  the  cases  to  be  subsequently  presented. 
Besides  the  lowered  rate  of  tapping,  the  most  striking  abnormality 
is  in  the  shape  of  the  curve.  This  always  drops  very  much  less 
than  the  normal,  and  in  the  case  oi  Ri  it  even  rises  considerably. 
The  interpretation  of  these  delayed,  or  even  negative  fatigue 
phenomena,  seems  to  be  that  assigned  independently  by  Hoch, 
Specht,  and  Hutt,  the  progressive  overcoming  of  the  retarda- 
tion. This  we  see  most  markedly  in  Ri,  where  the  curve  is 

•''The  results  with  a commensurate  group  of  women  were  similar  so  far 
as  the  present  comparisons  are  concerned.  Cf.  Am.  J.  Ps.,  XX,  1909,  pp. 

353-363. 


1909] 


FREDERIC  LYMAN  WELLS 


II 


almost  the  reverse  of  the  normal.  The  first  interval  should 
normally  be  the  best;  here  it  is  the  worst.  Whenever  the  per- 
formance of  the  first  interval  is  surpassed  by  the  performance 


29 

E-8 


27 


of  a later  interval,  this  will  be  known  as  reversal.  Besides  its 
conspicuous  appearance  in  Ri,  reversal  is  seen  less  markedly  in 
Li  and  in  R2,  where  the  second  interval  surpasses  the  first.  The 


12 


MOTOR  RETARDATION 


[July 


fs  of  all  these  curves  are  naturally  very  much  above  the  normal, 
being  as  follows : 


Rl 

R2 

LI 

L2 

Normal  average  

90 

.91 

.88 

.90 

Typical  depressed  case 

1.08 

.99 

•99 

.96 

It  is  also  very  striking  how  much  faster  the  second  experiment 
is  than  the  first.  Such  a difiference  is,  so  far  as  I know,  never 
observed  in  normal  cases.  The  practice  effect  in  two  such  ex- 
periments is  negligible.  There  is  thus  indicated  very  much  less 
retardation  in  the  second  experiment  than  the  first,  and  this  is 
confirmed  by  the  fact  that  the  curves  of  the  second  experiment 
(dotted  lines)  are  much  closer  to  the  normal  shape  than  those 
of  the  first.  The  right  hand  shows  much  less  of  the  abnormal 
“ reversal,^’  the  left  none  at  all.  We  see,  however,  that  the  dotted 
lines  are  very  much  farther  apart  than  the  continuous  ones.  This 
here  indicates  the  following  hand  to  be  the  more  favored,  and  is 
the  contrary  to  what  we  find  normally.  It  is  as  though  the  work 
done  with  the  first  hand  helped  to  overcome  the  resistances  to 
be  encountered  by  the  second  hand.  To  this  rather  characteristic 
favoring  of  the  following  hand  has  been  applied  the  name  of 
transference.  The  lowered  absolute  rate  and  the  abnormal  pres- 
ence of  reversal  and  transference  are  the  essential  phenomena  of 
retardation  as  given  in  the  present  results. 

The  principal  source  of  error  in  these  observations  is  imposed 
by  limitations  in  material  that  are  scarcely  avoidable  in  the  groups 
investigated.  Whenever  we  wish  to  make  a comparison  between 
a normal  and  a pathological  group,  it  is  desirable  that  the  groups 
be  as  similar  as  possible,  save  in  the  characters  to  be  investigated ; 
otherwise  it  is  possible  that  other  characters  than  those  investi- 
gated are  responsible  for  the  peculiarities  noted.  The  greatest 
difficulty  is  that  of  age.  This  objection  applies  with  about  equal 
force  in  the  analogous  experiments  of  Hutt  and  of  Specht,  and 
in  those  of  the  writer.  Thus  Specht’s  traumatic  cases  form  a 
fairly  homogeneous  group,  and  so  do  his  normal  cases,  but  their 
averages  are  many  years  apart,  the  normal  individuals  being  for 
the  most  part  in  the  twenties,  the  traumatic  cases  well  along  in 
middle  life.  So  here,  the  normal  group  would  average  about  the 
same  as  that  of  Specht,  the  depressions  probably  somewhat  older, 
and  much  more  variable.  Of  how  much  this  factor  has  influenced 


1909] 


FREDERIC  LYMAN  WELE^ 


13 


the  results,  we  can  judge  only  indirectly.  The  phenomena  do  not 
seem  dependent  upon  age  within  the  normal  or  depressed  groups, 
seeming  in  the  latter,  at  least,  much  more  dependent  upon  changes 
in  the  condition  than  upon  age,  nor  are  they  sufficiently  evident 
in  equally  old  cases  of  other  psychoses.  The  manic  group,  for- 
tunately, is  sufficiently  homogeneous  with  the  normal  to  be  ca- 
pable of  direct  comparison. 

We  may  now  proceed  to  study  the  results  of  the  method  in  a 
number  of  special  cases.  Of  cases  I,  II,  III,  IV,  V,  and  VIII 
mention  has  been  made  in  a previous  study,  American  Journal 
of  Psychology,  Vol.  XX,  pp.  38-59.  In  this  previous  study  they 
are  respectively  cases  XII,  IV,  VIII,  X,  XI,  and  III. 

2.  Clinical  Histories  and  Experimental  Results. 

Case  I.  On  account  of  existing  uncertainties  as  to  the  relation- 
ship of  certain  depressive  states  to  psychasthenic  conditions  and 
to  hysteria  the  following  case,  which  can  now  with  considerable 
certainty  be  assigned  to  the  manic-depressive  group,  is  perhaps 
of  special  interest.  The  patient  is  a man  of  61,  with  some  hered- 
ity, described  as  having  always  been  a very  nervous  man.  A 
six  months’  mental  breakdown  occurred  at  38  and  another  at  40. 
Since  then  there  have  been  no  marked  upsets  until  the  present 
time,  though  he  has  been  continually  apprehensive  and  hypo- 
chondriacal. He  would  often  get  slightly  depressed,  but  never 
sufficiently  so  to  give  up  his  work.  Regarding  these  {Abortivcm- 
fdllef)  he  has  said  that  it  was  “ hard  to  concentrate  his  mind,” 
“ became  very  blue,”  “ did  not  want  to  do  anything,”  “ all  these 
attacks  begin  with  a sense  of  ennui  of  work.”  The  patient  is  a 
man  of  exceptional  intellect  and  refinement.  Physically,  he  has 
always  been  fairly  healthy,  though  he  mentions  having  had  dizzy 
spells  since  childhood,  and  he  has  taken  mercury  and  arsenic 
for  an  enlarged  liver. 

The  beginning  of  the  fixed  ideas  which  color  the  present  attack 
is  referred  subjectively  to  an  episode  about  18  months  before  ad- 
mission when  the  patient,  reading  of  a case  of  mercurial  poison- 
ing who  had  injured  his  family,  began  to  fear  a similar  impulse. 
This  fear  became  so  strong  that  on  one  occasion  he  appealed  to 
the  police  to  restrain  him,  and  during  the  latter  part  of  this 


14 


MOTOR  RETARDATION 


[July 


period  he  remained  away  from  his  family,  though  wanting  very 
much  to  be  with  them.  During  this  time  he  underwent  some 
hypnotic  and  psychoanalytic  treatment  with  negative  results,  and 
there  are  recorded  three  ineffectual  attempts  at  suicide.  With 
this  subject  the  regular  experiment  was  performed  four  times; 
on  August  19  and  27,  and  December  23,  1907,  and  February  24, 
1908. 

The  first  two  experiments  were  performed  within  about  a month 
after  the  patient’s  admission.  In  the  first  experiment  the  ^subject 

^7 


/ 

L/ 


seemed  to  co-operate  willingly,  although  expressing  many  de- 
pressive ideas,  especially  toward  the  close  of  the  experiment,  when 
he  talked  more.  This  experiment  was  made  in  the  afternoon, 
while  the  experiment  of  a week  later  was  made  in  the  morning, 
and  at  this  time  he  was  more  depressed.  The  curves  in  these 
experiments  are  as  shown  in  Fig.  4. 

These  records,  especially  those  in  the  second  experiment,  are 
as  marked  illustrations  of  intraserial  warming  up  and  reversal 
as  the  writer  has  observed.  The  first  interval  is  always  the 
worst,  while  in  only  one  of  the  records  is  the  final  interval  sur- 
passed by  an  earlier  one.  For  the  period  used,  therefore,  the 


1909] 


FREDERIC  LYMAN  WELLS 


15 

fatigue-curves  are  almost  the  reverse  of  the  normal.  The  trans- 
ference’’  phenomenon  is,  however,  altogether  absent;  if  any- 
thing, it  is  the  preceding  hand  which  is  more  favored. 

During  the  time  up  to  the  next  experiment  the  patient  was 
clinically  noted  to  improve  somewhat,  and  he  began  to  occupy 


SeriesI  ^3  45^/2.34  S 

Fig.  S- 

himself  with  various  intellectual  pursuits  that  interested  hirn. 
A physician’s  note  of  his  condition  of  January  i,  1908,  reads  in 
part : “ The  patient  eats  and  sleeps  well  and  takes  a moderate 
amount  of  exercise,  though  a great  deal  of  his  time  is  spent  in 
his  room  where  he  reads  and  writes.  He  is  always  cheerful 
and  agreeable.  He  was  granted  parole  of  the  grounds  on  Octo- 
ber 23.  Since  then  he  has  taken  several  trips  to  Cambridge  with 


i6 


MOTOR  RETARDATION 


[July 


his  friends.  These  he  invariably  enjoys.”  A nurse’s  note  made 
the  day  before  the  third  experiment  speaks  of  him  as  ‘‘  doing 
well,  seems  more  cheerful.”  We  have  apparently  to  do,  therefore, 
with  some  progressive  improvement  in  the  patient’s  condition 
which  may  be  compared  with  the  difference  in  response  to  the 
test. 

The  curves  in  the  third  experiment,  December  23,  1907,  are 
as  shown  in  Fig.  5. 

The  most  striking  feature  of  these  curves  is  that  the  curves 
of  the  two  hands  are  of  a totally  opposite  type.  The  right  hand, 
which  precedes,  shows  a typically  reversed  curve,  while  the  left 
hand,  which  follows,  shows  a curve  much  more  approximating 
the  normal,  with  reversal  only  in  the  second  interval.  It  is  to 
be  noted  also  that  while  the  left  hand  was  inferior  to  the  right 
in  both  previous  experiments,  it  is  now  markedly  superior  to  it. 
These  phenomena  indicate  a considerable  progressive  change  in 
the  fatigability  of  the  two  hands  throughout  the  experiment.  The 
character  of  this  change  is  best  shown  in  the  curve  of  the  f itself, 
given  below  the  rate  curves  for  the  two  hands.  It  will  be  ob- 
served that  regardless  of  the  hand  used,  the  f shows  a progressive 
decrease  throughout  the  two  records.  That  is,  the  further  the 
“ resistances  ” of  the  depression  are  overcome  by  the  work  in 
hand,  the  more  do  the  characteristics  of  the  retarded  work-curve 
disappear,  and  the  more  does  the  work-curve  approach  a normal 
character,  with  fs  below  i.oo.  In  the  first  two  experiments  the 
patient  responded  to  these  warming-up  influences  only  within  a 
single  series,  thus  affording  in  both  hands  fairly  typical  reversed 
curves ; but  now,  after  a certain  interval  marked  clinically  by 
improvement  in  condition,  the  warming-up  influence  extends  not 
only  from  series  to  series,  but  progressively  throughout  the  rec- 
ords. An  examination  of  the  individual  fatigue-curves  shows 
how  the  earlier  ones  are  typically  reversed,  and  how  this  condi- 
tion gradually  changes  over  into  the  normal.  The  first  curve 
of  the  experiment,  made  with  the  right  hand,  runs  25 — 27 — 27 — 
28 — 29 — 29,  f 1. 12,  a typically  reversed  curve;  the  last  curve  of 
the  experiment,  made  with  the  left  hand,  runs  30 — 28 — 28 — 27 — 
26 — 26,  f .90,  a typical  normal  curve.  The  apparent  superiority 
of  the  left  hand  to  the  right  is  presumably  a real  “ transference  ” 
phenomenon. 


1909] 


FREDERIC  LYMAN  WELLS 


17 


The  points'  indicated  in  this  experiment  appear  still  more  strik- 
ingly in  the  experiment  made  February  23,  1908.  When  the 


5criej5|  2.3  4«S"i2.34  5" 

Fig.  6. 

patient  was  sent  for  he  was  asleep,  and  had  to  be  awakened  to 
come  to  the  laboratory.  On  arriving  there,  although,  as  usual, 


2 


i8 


MOTOR  RETARDATION 


[July 


entirely  clear,  he  showed  a depression  and  apprehensive  manner 
not  much  out  of  keeping  with  his  condition  when  first  observed. 
This  wore  off  during  the  experiment,  at  the  conclusion  of  which 
he  was  quite  smiling  and  talkative.  The  curves  are  as  shown  in 

Fig.  6. 

We  observe  here  a marked  increase  in  absolute  rate,  which  could 
hardly  be  associated  with  other  than  a changed  condition  of 
the  patient.  It  is  beyond  the  limits  of  both  probable  error  and 
practice  improvement.  There  is  to  a lesser  degree  the  same 
difference  between  the  preceding  right  and  the  following  left 
hands  as  appeared  in  the  third  experiment.  The  right  hand  has 
reversal  in  the  second  interval,  and  shows  very  little  fatigue ; 
the  left  hand  has  no  reversal,  and  even  fatigues  a little  more 
than  the  normal.  There  is  thus  shown  the  same  change  in  the 
conditions  of  fatigability,  of  which  the  curve  of  the  fs  again 
affords  the  best  index.  As  in  the  previous  case,  this  curve  shows 
a progressive  tendency  to  fall,  though  the  fall  is  now  confined 
to  the  first  half  of  the  experiment,  while  in  the  third  experiment 
it  persisted  through  the  whole  of  it.  Although  this  does  not 
appear  in  the  curves  quoted,  it  should  also  be  mentioned  that 
the  absolute  rate  of  the  five  successive  series  now  progressively 
increases  in  both  hands,  in  the  preceding  right  hand  more  than 
in  the  following  left  hand,  whereas  in  the  previous  experiment 
this  was  evident  only  in  the  following  left  hand.  The  indications 
are  that  the  patient  is  now  much  more  susceptible  to  these  warm- 
ing-up influences,  since  they  occur  sooner  in  the  experiment,  and 
cover  a wider  range  of  improvement.  The  first  right  hand 
series  is  the  slowest  in  all  four  experiments,  with  133  taps,  show- 
ing a curve  with  but  slight  reversal,  which,  however,  persists 
throughout,  21 — 22 — 23 — 22 — 23 — 22,  f 1.07.  It  is  interesting 
to  compare  this  with  the  second  series,  which  in  spite  of  its  high 
f,  1. 21,  shows  much  less  reversal.  It  runs  26 — 30 — 34 — 33 — 30 — 
30 ; i.  e.,  a low  initial  rate,  quickly  warming  up  to  the  maximum, 
and  then  fatiguing  normally.  After  this  the  fs  drop  below  i.oo, 
though  the  individual  curves  do  not  assume  a normal  character 
until  the  last  right  hand  series  is  reached,  running  36 — 34 — 32 — 
32 — 31 — 31,  f .89.  The  curves  of  the  left  hand  are  all  per- 
fectly normal,  as  the  averages  indicate,  except  that  at  the  con- 
clusion of  the  experiment  there  seems  to  have  been  a marked 


FREDERIC  LYMAN  WELLS 


19 


1909] 

Schlussantrieb.  Superficially  then,  we  had  in  this  experiment  a 
condition  of  depression  apparently  associated  with  the  subject’s 
just  having  been  aroused  from  sleep,  which,  under  the  keying-up 
influence  of  the  experiment  (often  very  noticeable,  even  in  nor- 
mal individuals)  gradually  “ swings  over  ” into  a condition  in 
which  the  mood,  at  least,  is  rather  hypomanic.  The  final  series 
of  this  experiment  are  also  not  dissimilar  from  those  obtained 
from  manic  cases. 

The  most  reasonable  interpretation  of  this  case  would  seem 
to  be  that  it  is  a manic-depressive  condition  which,  owing  to 
factors  in  the  patient’s  make-up,  is  dominated  by  impulsive  ideas. 
The  depression  is  not  secondary  to  the  fixed  ideas,  but  it  is  the 
fixed  ideas  which  are  secondary  to  the  depression.  This  is  further 
evidenced  by  the  fact  that  the  content  of  the  patient’s  depressive 
ideas  has  recently  changed  somewhat  and  become  more  typical 
of  what  is  ordinarily  seen.  The  striking  evidence  of  a motor 
retardation  which  these  experiments  afford  throws  an  interesting 
sidelight  on  the  fundamental  character  of  the  depressive  symptoms. 

Case  II.  Market  gardener,  65,  some  heredity.  As  a boy  he 
was  quiet  and  retiring,  of  a rather  “ artistic  ” temperament, 
learned  well  at  school.  Leaving  school  at  18  on  account  of 
illness,  he  went  into  business,  his  occupation  being  neither 
eventful  nor  exacting.  The  first  attack  occurred  at  42,  without 
cause,  showing  depression  and  inadequacy.  It  was  mild  and 
did  not  interrupt  his  work.  During  the  next  16  years  there  were 
some  half  dozen  similar  attacks,  which  seemed  to  be  followed 
by  hypomanic  states.  Then  attacks  of  three  or  four  months 
began  to  occur  every  winter,  characterized  by  depression,  inade- 
quacy, tendency  to  worry,  and  restlessness.  These  were  also 
followed  by  slight  exhilarations.  The  patient  was  admitted 
in  the  attack  previous  to  the  present,  which  was  the  sixteenth. 
At  this  time  involution  symptoms  began  to  appear  in  exaggerated 
apprehensiveness  and  a restlessness  occasionally  “ breaking 
through  ” the  retardation.  He  was  discharged  very  much  im- 
proved after  some  six  weeks,  and  got  along  fairly  well  at  home 
for  about  a year,  when  he  again  became  depressed,  with  delu- 
sions, suspiciousness  and  restlessness,  and  was  readmitted  two 
months  later.  He  was  entirely  clear  about  his  surroundings,  but 
showed  much  inadequacy  and  self-accusation. 


20 


MOTOR  RETARDATION 


[July 


The  regular  experiment  was  performed  twice.  In  interpreting 
the  records  it  must  be  borne  in  mind  that  the  subject  does  better 


32,1 


N. 


.1 

✓ 


Fig.  7. 


with  the  left  hand  than  with  the  right.  The  upper  continuous 
and  dotted  lines  are  thus  those  of  the  left  hand.  The  curves  are 
as  above. 


1909]  FREDERIC  LYMAN  WELLS  21 

The  most  striking  point  in  these  records  is  the  difference  be- 
tween the  first  and  the  second  experiments.  The  first  experiment 
shows  little  abnormal  in  the  shape  of  its  curves,  and  its  absolute 
rate  is  far  beyond  the  limits  of  probable  error  above  that  of  the 
second,  which  also  shows  marked  evidence  of  intraserial  warming 
up.  As  there  could  hardly  have  been  such  changes  in  superficial 
co-operativeness,  the  most  natural  indication  is  a change  in  the 
patient's  condition.  No  such  change  can  be  traced  in  the  clinical 
notes  made  independently  of  the  experiments,  though  it  was 
noted  by  the  writer  that  the  depression  did  seem  somewhat  deeper 
at  the  time  of  the  second  experiment.  It  would  seem,  then,  that 
whatever  the  change  in  the  patient’s  condition  may  have  been, 
it  was  not  one  which  was  likely  to  be  apparent  to  ordinary  obser- 
vation. The  clinical  notes  speak  of  the  patient’s  condition  as 
fluctuating  a good  deal  from  day  to  day,  but  give  no  indication 
that  this  was  one  of  his  poorer  days. 

Very  shortly  after  these  experiments  the  patient  left  the  hos- 
pital on  a visit,  and  appeared  very  well  for  the  first  few  days 
at  home.  Then  delusional  ideas  began  to  return,  coupled  with 
restlessness  and  apprehension,  which  resulted  in  his  return  to 
the  hospital  some  three  and  one-half  months  subsequently.  Eight 
months  later,  a little  over  a year  after  the  first  two  experiments, 
a third  experiment  was  performed,  whose  results  were  very 
characteristic.  The  depression  was  deeper  than  at  either  of  the 
two  previous  experiments.  On  being  questioned  a little  when  he 
came  to  the  laboratory,  his  answers  were  very  long  in  coming, 
but  when  they  did  arrive  they  were  quick,  sharp,  and  decisive. 
He  was  constantly  fidgeting  about,  and  showed  very  strikingly 
that  the  retardation  was  specifically  one  of  the  time  of  the  outward 
reaction  to  the  impulse,  and  not  a matter  of  the  absence  or  abso- 
lute feebleness  of  the  impulses  themselves.  He  denied  feeling 
blue,  but  said  he  felt  “ bad.”  During  the  course  of  the  experi- 
ment his  general  motor  activity  increased,  and  it  was  noted  that 
he  answered  questions  more  promptly,  and  began  a series  of 
tapping  sooner  after  the  signal  was  given.  Toward  the  end  of 
the  experiment  he  also  spoke  spontaneously.  It  was  evident  to 
ordinary  observation  that  there  was  markedly  less  retardation  at 
the  end  of  the  experiment  than  at  the  beginning.  The  curves  are 
as  below. 


L 


*7 

>4 

IS 


Saries  12.345’  I Z 3 4 5 

Fig.  a 


FREDERIC  LYMAN  WELLS 


23 


1909] 

The  simple  curves  for  the  right  and  left  hands  show  little  of 
significance.  There  is  a tendency  to  reversal,  which,  however, 
is  not  maintained  after  the  second  interval.  The  undistinctive 
character  of  these  curves,  however,  is  due  wholly  to  the  fact 
that  the  progressive  overcoming  of  the  retardation  already  noted 
clinically,  produces  so  great  a variation  in  the  individual  series 
that  in  simply  taking  the  average  for  the  intervals  the  progressive 
changes  are  masked.  The  number  of  taps  in  each  of  the  five  indi- 
vidual series  with  the  right  and  left  hands  is  as  follows: 

Number  of  Taps  in  30  Seconds. 


Right  hand  93  62  82  8l  99 

Left  hand  123  96  102  125  157 


The  characteristic  in  both  hands  is  a relatively  high  rate  in 
the  first  series,  which  drops  to  a minimum  in  the  second,  and 
then  increases  to  the  end.  In  each  hand  a low  initial  performance 
seems  to  be  broken  through  by  special  influences  at  the  beginning, 
after  which  the  retardation  again  asserts  itself,  only  to  be  over- 
come by  the  activities  of  the  test.  If  we  compare  the  relationship 
of  the  right  and  left  hands  in  this  experiment  to  their  relationship 
in  the  other  two  experiments,  there  is  evident  a marked  trans- 
ference phenomenon,  i.  e.,  undue  favoring  of  the  following  hand. 
The  left  hand  here  averages  half  as  fast  again  as  the  right,  while 
in  the  previous  experiments  it  was  only  slightly  more  rapid.  The 
series  in  this  experiment  show  a wider  variation  in  rate  than 
occurs  in  any  other  experiment  the  writei;  has  made. 

This  variation  is  related  in  a rather  significant  way  to  the 
fatigue  phenomena  which  the  successive  series  show.  The  course 
of  the  fs  through  the  successive  series  is  plotted  in  the  same  way 
as  for  Case  I.  The  fs  begin  low  but  at  once  mount  very  high, 
showing  a great  amount  of  reversal  and  then  a gradual  tendency 
to  decrease  to  the  end.  Thus  at  the  beginning  of  the  experiment, 
at  the  period  of  greatest  retardation,  there  was  within  the  indi- 
vidual series  no  response  to  the  warming-up  influences  at  all,  the 
first  series  running  19 — 16 — 14 — 15 — 15 — 14,  f .79.  Later,  when 
the  retardation  is  more  overcome,  we  do  find  this  response  to 
intraserial  warming  up,  obtaining  such  series  as  the  fifth,  with 
the  right  hand,  running  14 — 15 — 18 — 18 — 18 — 16,  f 1.22. 
Finally,  the  retardation  is  so  far  overcome  that  the  best  efforts 


24 


MOTOR  RETARDATION 


[July 


are  put  forth  immediately  with  no  delay  in  warming’  up,  e.  g.^ 
with  the  fifth  series  in  the  left  hand  running  27 — 27 — 27 — 26 — 
25 — 25,  f .96,  with  no  actual  reversal  at  all. 

These  records  illustrate  especially  a point  in  which  the  writer 
has  quoted  certain  interpretations  of  Hutt."  The  most  profound 
conditions  of  retardation  may  present  no  response  at  all  to  the 
warming-up  influences  of  the  activities  of  the  test,  and  a gradual 
overcoming  of  retardation  is  first  seen  in  the  ability  to  respond 
to  these  warming-up  influences  (as  shown  in  the  reversed  curves), 
while,  finally,  the  retardation  being  still  further  overcome,  the 
fatigue-curve  again  more  approximates  the  normal  in  form. 

Case  III.  Retired  manufacturer,  71,  some  heredity.  An  in- 
dustrious and  hard-working  man  all  his  life,  of  best  habits,  re- 
tiring from  business  a few  years  ago,  after  he  had  made  a 
moderate  fortune.  Although  always  having  given  a certain 
amount  of  his  time  to  church  work,  at  about  this  period  he  began 
to  show  excessive  interest  in  religious  activities  that  indicates 
the  possibility  of  a hypomanic  condition.  Then  matters  went 
along  about  normally  for  a year,  when  three  or  four  months 
before  admission  he  was  noticed  to  be  sleepy,  apt  to  lie  down, 
slow  to  understand,  lacking  the  power  to  start  things.  He  also 
began  to  worry  about  financial  matters,  but  no  real  mental  cause 
of  this  or  any  other  nature  is  known.  For  a brief  period  before 
admission  he  spoke  openly  of  suicide.  At  the  time  of  the  experi- 
ments he  was  perfectly  clear  and  oriented,  and  formed  a striking 
example  of  those  cases  who,  with  a first  attack  at  the  involution 
period,  yet  show  none  of  the  characteristic  involution  symptoms, 
but  form  a typical  picture  of  manic-depressive  depression. 

With  this  subject  the  regular  experiment  was  performed  10 
times,  first  on  July  6,  1908,  three  days  after  admission;  again 
on  July  15,  and  daily  for  the  eight  days  following.  The  averages 
of  the  six  intervals  are  given  in  the  curves  subjoined,  the  experi- 
ments in  which  the  right  hand  precedes  being  sketched  in  a con- 
tinuous line,  those  in  which  the  left  hand  precedes  being  sketched 
in  a dotted  line  (Fig.  9). 

■The  absolute  rate  is  somewhat  below  the  normal,  and  there 

*Hutt:  Rechenversuche  bei  Manisch-Depressive,  Ps.  Arb.,  V.  3 (1908), 
PP-  338-370.  Wells : Studies  in  Retardation,  Am,  J.  Ps.,  XX,  pp.  49-50. 


1909] 


FREDERIC  LYMAN  WELLS 


25 


is  considerably  less  fatigue  loss  than  the  normal,  as  is  usually 
the  case.  On  the  other  hand,  except  for  those  with  the  right 
hand  preceding,  the  curves  show  no  real  reversal,  but  each  indi- 
vidual curve  runs  along  about  on  a level  with  no  marked  fluctua- 
tion. The  subject  co-operated  with  active  willingness,  and  seemed 
always  anxious  to  do  his  best ; so  that  although  there  is  no  actual 
reversal,  the  curves  probably  present  a real  over-balancing  of 
fatigue  loss  in  the  constant  maintenance  of  a low  but  maximum 
rate. 

The  transference  phenomena,  which  are  the  most  striking  ex- 
perimental features  of  retardation  in  this  case,  are  superficially 


Fig.  9. 

shown  in  the  above  quoted  curves,  the  dotted  lines  being  farther 
apart  than  the  continuous  ones,  showing  here  that  the  following 
hand  is  the  more  favored.  They  are  presented  in  greater  detail 
in  the  accompanying  curves  (Fig.  10). 

Bearing  now  in  mind  that  on  the  odd  days  the  right  hand 
precedes  the  left,  while  on  the  even  days  the  left  hand  precedes 
the  right,  the  more  favorable  position  of  the  following  hand  is 
evident.  This  is  very  seldom  seen  in  normal  individuals,  except 
in  a late  stage  of  practice.  In  the  curve  for  the  index  of  right- 
handedness  the  index  is  invariably  low  {i.  e.,  the  left  hand  rela- 
tively poorer)  Vv^hen  the  left  hand  precedes,  and  high  when  It 
follows;  on  the  fifth  day  the  right  and  left  hands  were  exactly 
equal.  With  the  sole  exception  of  the  last  day,  the  index  rises 


26 


MOTOR  RETARDATION 


[July 


on  the  odd,  and  falls  on  the  even  days.  This  result  corresponds 
closely  to  that  obtained  by  Hoch  in  a similar  case  with  the  ergo- 
graph  {Psychol.  Bull.,  I,  255).  With  respect  to  f the  left  hand  is 


Fig.  10. 


subject  to  a certain  constant  influence  that  may  be  in  the  nature 
of  practice  effect,  but  the  alternation  of  the  right  hand  fs  is 
perfectly  clear  cut.  They  are  high  on  the  even  days  when  the 
right  hand  follows,  and  low  on  the  odd  days  when  it  precedes. 
Such  warming-up  effect,  then,  as  is  transferred  from  the  pre- 


FREDERIC  LYMAN  WELLS 


27 


1909] 

ceding  left  to  the  following  right  hand,  shows  itself  in  a greater 
immunity  to  fatigue  in  the  right  hand ; when  it  has  not  this 
warming-up  influence  behind  it,  it  is  distinctly  more  susceptible 
to  fatigue  losses. 

In  the  curves  of  the  total  efficiency  from  day  to  day,  one  can 
trace  the  same  relationship  of  the  right  and  left  hands  that  the 
index  of  right-handedness  shows  with  more  fidelity;  but  it  is 
necessarily  obscured  by  the  intercurrent  changes  in  the  patient’s 
condition.  The  writer  made  a brief  daily  note  of  the  patient’s 
apparent  condition  (before  evaluating  the  experiment,  of  course), 
the  main  points  of  which  are  as  follows: 

1.  July  9.  Patient  clear,  did  not  seem  much  depressed,  but 
expressed  spontaneously  a feeling  of  apprehensiveness  as  dis- 
tinguished from  depression. 

2.  July  15.  Did  not  seem  to  take  as  much  interest  as  pre- 
viously. Seemed  rather  more  depressed.  Spoke  spontaneously 
twice. 

3.  July  16.  Mentioned  spontaneously  feeling  a little  more 

cheerful,  as  he  had  been  doing  some  things  in  which  he  was  in- 
terested. Made  an  adjustment  in  the  apparatus  of  his  own 
accord.  Walked  about  the  laboratory  afterwards,  examining 
apparatus.  j 

4.  July  17.  Said  he  felt  worse  than  day  before,  and,  in  general, 
seemed  more  depressed. 

5.  July  20.  Subject  about  the  same.  Cannot  lie  down  to 

rest  on  account  of  the  depressive  ideas  that  come  on  him  at  such 
times.  ' 

6.  July  21.  Subject  felt  a little  better  than  usual,  according 
to  his  own  statement.  Did  not  talk  so  much. 

7.  July  22.  Talked  a good  deal  more  freely.  Subjective  con- 
dition better  than  previously.  Spoke  of  a certain  series  (wrongly) 
as  the  best  yet. 

8.  July  23.  Felt  worse  than  day  before,  did  not  talk  so  much. 

9.  July  24.  Subject  mentioned  feeling  “alert”  in  contrast  to 
usual  “ numbness  ” ; more  alert  to-day  than  at  any  previous  time. 
Thought  was  doing  better.  Talked  depressively,  but  a good  deal. 

10.  July  25.  Not  nearly  so  “ alert  ” as  day  before.  About  as 
usual. 


28 


MOTOR  RETARDATION 


[July 


The  nurse’s  notes,  covering  this  period,  contain  nothing  con- 
tradictory to  the  above  observations.  It  should  be  mentioned  that 
these  memoranda  are  derived  mainly  from  immediate  observation 
of  the  subject,  only  secondarily  from  the  subject’s  introspective 
account  of  his  condition.  It  is  rare,  indeed,  that  a depressed 
patient  will  admit  feeling  better  until  recovery  is  far  advanced ; 
they  often  struggle  against  such  an  admission,  long  after  im- 
provement is  clinically  evident. 

As  we  should  expect,  there  is  indicated  a tendency  for  the  gross 
rate  to  be  higher  on  good  days,  and  lower  on  poor  ones.  The  two 
extremes  of  condition,  the  second  and  ninth  days,  are  marked 
by,  respectively,  the  worst  and  the  best  performances  in  the  test. 
For  the  other  days  there  is  nothing  special  to  note,  except  that 
on  the  seventh  and  tenth  days  the  apparent  chcmge  in  condition 
was  sufficient  to  affect  both  hands  in  the  same  direction ; the 
curves  usually  run  in  opposite  directions  owing  to  the  trans- 
ference of  “ warming  up.” 

While  the  series  made  on  a single  day  vary  less,  the  day-to- 
day  variability  in  this  subject  is  a good  deal  more  than  the  normal,, 
and  there  may  also  be  noted  the  absence  of  practice  effect.  It 
seems  to  be  a frequent  observation  with  pathological  subjects  that 
susceptibility  to  practice  (Uehiingsfdhigkeit)  is  decreased,  but 
this  is  probably  secondary  to  inferior  co-operation,  the  normal 
practice  improvement  demanding  a degree  of  doing  one’s  best 
that  is  probably  never  attained  in  this  class  of  subjects,  even  under 
the  conditions  of  greatest  apparent  willingness. 

The  following  figures  give  the  averages  and  m.  v.’s  of  the 
quantities  expressed  in  the  foregoing  curves,  classified  according 
to  the  preceding  hand: 


Index  of  right- 
handedness. 

/(rt.  hd.) 

Gross  rate 
rt.  hd. 

Gross  rate 
1ft.  hd. 

Av.  m.  V. 

Av. 

m.  V. 

Av. 

m.  V. 

Av.  m.  V. 

Right  hand  preceding  .960  .018 

.966,  .001 

1595 

2.9 

153.3 

2.0 

Left  hand  preceding..  .925  .022 

.989 

.006 

159-9 

1.8 

148.2 

2.4 

The  differences  in  favor  of  the  following  hand  are  small,  but 
save  in  one  case  well  beyond  the  limits  of  probable  error. 

Case  IV.  Machinist,  59,  heredity  unknown,  grammar-school 
education.  The  case  is  one  of  rapidly  recurring  and  rather  short 
depressions  recurring  at  intervals  of  about  two  years,  since  their 


FREDERIC  LYMAN  WELLS 


29 


1909] 


commencement  at  37  years  of  age.  The  attack  in  which  the 
present  experiments  were  made  is  much  the  longest  of  them, 
having  lasted  with  one  slight  remission  for  nearly  two  years; 
the  patient  was  well  on  the  road  to  recovery  at  the  time  of  making 


L 

Fig.  II. 


the  experiment,  and  has  since  recovered  and  gone  into  another 
depression.  There  have  been  no  excitements. 

Two  experiments  were  performed  on  succeeding  days.  On 
the  first  day  the  patient  made  a fairly  normal  appearance,  co- 
operating willingly  all  the  while,  though  seeming  to  brighten  up 


30 


MOTOR  RETARDATION 


[July 


somewhat  during  the  experiment.  This  experiment  took  place 
at  3.30  p.  m.  The  following  one  was  arranged  for  10  a.  m.,  and 
it  was  arranged  that  the  patient  should  be  left  quiet  up  to  this 
time,  with  the  not  unexpected  result  that  the  patient’s  mood  was 
considerably  less  cheerful  at  this  experiment.  The  records  also 
reflect  a characteristic  change  in  the  motor  sphere,  being  as 
shown  in  Fig.  ii. 

As  in  Case  III,  there  are  no  clear-cut  phenomena  of  reversal, 
though  the  fs  are  considerably  greater  than  the  normal.  On  the 
other  hand  there  is  much  greater  fatigue  loss  in  the  second  ex- 
periment (dotted  lines)  than  in  the  first;  that  is,  the  individual 
series  show  the  greater  susceptibility  to  fatigue  at  the  time  when 
retardation  is  objectively  the  most  prominent,  just  as  did  the 
earlier  series  of  the  third  experiment  with  Case  II.  The  most 
abnormal  feature  of  the  records  is  again,  however,  found  in  the 
transference  phenomena.  In  the  first  experiment,  performed  in 
the  afternoon,  the  right  hand  record  averages  somewhat  below 
normal ; but  the  left  hand,  which  follows  the  right,  is  much  above 
normal  for  the  left  hand,  and  even  considerably  surpasses  the 
performance  of  the  preceding  right  hand.  In  the  second  experi- 
ment the  left  hand,  which  now  precedes,  has  the  poorest  record 
of  all,  but  the  right,  now  in  the  favored  position,  is  much  better 
than  the  left,  though  it  does  not  reach  its  average  of  the  previous 
day.  We  thus  have  an  immunity  to  fatigue  and  a transference 
effect  above  the  normal,  with  a drop  in  gross  rate  and  increased 
susceptibility  to  fatigue  associated  with  an  objectively  given 
poorer  condition.® 

Case  V.  Market  salesman,  55,  a slight  heredity.  As  a boy, 
bright  and  active,  learned  well  at  school,  which  he  left  at  15 
to  work  in  a store.  He  was  quite  successful  in  business,  though 
when  about  45  he  had  a financial  setback  that  gave  him  consid- 
erable anxiety,  which,  however,  he  threw  off  well.  During  the 
last  few  years  he  has  also  worried  somewhat  over  dulness  in  the 
market. 

The  present  trouble  has  its  origin  in  a railroad  accident,  which 

® Cases  IV,  VI,  and  XI  were  patients  in  the  Boston  Insane  Hospital. 
For  access  to  these  cases  and  for  their  histories  grateful  acknowledgement 
is  made  to  the  officers  of  this  institution. 


FREDERIC  LYMAN  WELLS 


31 


1909] 

made  him  a cripple  and  necessitated  two  surgical  operations.  The 
shock  of  the  accident  and  the  main  operation  he  bore  well,  and 
kept  in  good  spirits  until  the  second,  a relatively  minor  operation, 
when  he  became  progressively  very  much  depressed,  growing 
nervous  and  irritable,  easily  disturbed  at  the  slightest  noise.  Then 
hypochondriacal  delusions  began  to  develop,  and  there  was  an 
attempt  at  suicide,  after  which  he  became  more  depressed,  and 

35 


was  removed  to  an  institution.  On  admission  to  the  McLean 
Hospital,  17  months  after  the  onset  of  the  psychosis,  the  patient 
was  restless,  irritable,  hypochondriacal,  complaining  of  great  fa- 
tigue. He  mentioned  feeling  worse  at  night.  Some  improvement 
was  noted  during  the  next  month,  after  which  his  condition  re- 
mained about  stationary.  Two  experiments  were  performed  about 
15  months  after  the  patient’s  admission,  the  curves  running  as 
shown  in  Fig.  12. 

It  is  interesting  to  note  that  in  spite  of  the  fact  that  this  pa- 


32 


MOTOR  RETARDATION 


[July 


tient  complained  greatly  of  the  exhaustion  induced  by  physical 
effort,  he  actually  showed  a little  better  performance  than  the 
normal,  and  this  precisely  because  of  an  almost  absolute  immunity 
to  fatigue  losses.  The  right  hand  shows  a considerable  amount 
of  reversal,  the  curve  of  the  second  experiment  being  more  typic- 
ally reversed  than  that  of  the  first,  though  the  f is  equal  in  each 
record.  The  left  hand  also  shows  more  tendency  to  reversal  in 
the  second  experiment  than  in  the  first.  There  is  no  transference 
phenomenon,  nor  is  there  any  objective  change  in  the  patient  to 
which  might  be  referred  the  fact  that  the  second  experiment,  be- 
sides showing  more  overcoming  of  retardation,  averages  from 
five  to  six  taps  better  than  the  first,  and  is  also  much  more 
constant. 

The  records  in  this  case  correspond  quite  closely  with  those 
obtained  in  the  sixth  subject  of  Specht  (Vp.  M.).*  This  subject, 
an  entirely  typical  traumatic  case,  differentiates  himself  markedly 
from  Specht’s  other  subjects  in  showing  a progressive  increase 
in  the  efficiency  of  performance  exactly  comparable  to  that  noted 
in  the  case  above.  Specht  also  attributes  this  to  Hemmungswirk- 
ungen,  which  the  course  of  the  experiment  tends  to  overcome. 
He  writes : “ Die  Hemmung  . . . . ist  hier  im  Beginn  der 
Arbeit  grosser  als  im  weiteren  Verlauf ; sie  schwindet  nicht,  aber 
in  ihrer  Wirkung  auf  den  Gang  der  Arbeitsleistung  wird  sie 
durch  die  arbeitsfordernden  Einflusse  der  Uebung  und  moglicher- 
weise  auch  der  Anregung  abgeschwacht.”  The  present  result 
would  seem  to  point  to  this  interpretation  in  the  case  of  Specht’s 
subject,  M.,  as  the  correct  one;  at  any  rate,  this  subject  repre- 
sents a totally  different  fatigue  condition  from  his  remaining  five 
subjects,  and  one  which  corresponds  much  more  closely  to  that 
observed  in  manic-depressive  depressions  with  the  tapping  test 
here,  and  with  the  addition  test  itself  by  Hutt.  However,  the 
clinical  data  given  by  Specht  mention  nothing  in  favor  of  a 
manic-depressive  condition  for  this  case.  In  the  present  subject 
the  diagnosis  was  more  doubtful.  There  was  a far  from  positive 
history  as  regards  previous  attacks,  and  this,  coupled  with  the 
obvious  origin  of  the  symptoms,  together  with  irritability  and 
complaint  of  exhaustion,  pointed  to  a traumatic  neurosis.  On  the 

* Specht:  Ueber  klinische  Ermudungsmessungen,  Arch.  f.  d.  Ges.  Psych., 
Ill,  1904,  pp.  316-318. 


FREDERIC  LYMAN  WELLS 


33 


1909] 

other  hand,  there  were  no  anaesthesias  or  paraesthesias,  and  the 
presence  of  a thinking  disorder  and  inadequacy  pointed  at  first 
in  the  direction  of  manic-depressive.  The  further  history  of 
the  case,  which  has  failed  to  improve,  indicates  that  clinically 
it  satisfies  better  the  present  conception  of  a traumatic  neurosis. 

There  are,  then,  two  possible  interpretations  of  these  two  cases : 
If  the  normal  situation  in  traumatic  neurosis  is  exceedingly  great 
fatigability,  as  Specht  has  found  it,  and  the  manic-depressive  de- 
pressions are  apt  to  exhibit  reversed  curves,  as  Hutt  and  the 
writer  have  found,  the  indications  for  these  two  subjects  are 
rather  in  favor  of  a psychosis  upon  a fundamentally  manic-de- 
pressive basis,  but  with  a more  or  less  accidental  traumatic  color- 
ing. There  is  the  alternative  possibility  that  traumatic  cases  may 
occasionally  show  the  same  phenomena  of  retardation  as  the 
manic-depressive,  without  its  having  any  further  influence  on  the 
clinical  picture. 

Case  VI.  From  a differential  standpoint,  this  is  perhaps  the 
most  interesting  of  the  cases  presented.  The  patient  is  a man 
aged  20,  no  occupation,  slight  heredity.  As  a child  he  seemed 
to  be  perfectly  normal,  but  did  not  get  along  well  during  the  latter 
part  of  his  school  life,  being  unable  to  keep  up  with  his  classes, 
and  has  of  late  been  growing  nervous.”  For  the  past  three  or 
four  years  he  has  had  an  enormous  appetite.  About  six  months 
before  admission  he  became  very  restless,  moved  about  quickly, 
would  tip  over  furniture,  and  so  on,  and  kept  constantly  on  the 
move,  though  he  sometimes  assumed  strange  positions.  About 
three  weeks  before  admission  he  said  that  he  saw  his  father,  who 
had  been  dead  for  six  months,  and  for  two  weeks  previous  he 
destroyed  his  clothing  and  was  very  careless  in  his  habits.  He 
was  noted  to  talk  to  himself. 

When  first  seen  by  the  writer  his  appearance  was  downcast 
and  melancholy.  He  would  hardly  answer  questions  at  all,  and 
then  only  very  slowly  and  briefly.  He  said  that  he  felt  blue. 
When  asked  if  he  felt  better  any  particular  time  of  the  day  he 
said  that  he  felt  better  in  the  afternoon.  The  immediate  picture 
was  one  of  depression  rather  than  one  of  apathy,  suggesting  the 
more  frequent  condition  in  youthful  manic-depressive  cases,  in 
which  the  retardation  tends  to  outweigh  the  affective  depression, 
and  his  conduct  during  the  experiments  was  in  conformity  with 


3 


34 


MOTOR  RETARDATION 


[July 

this  interpretation.  He  did  not  speak  spontaneously,  and  from 
the  time  of  the  experiments  until  he  was  next  seen  he  was 
reported  not  to  have  spoken  at  all.  At  this  time  he  came  into 
the  room  slowly,  looking  not  so  much  depressed.  Asked  if  he 
had  ever  seen  the  speaker  before  he  replied,  “ Yes.”  How  long 
ago  was  it?”  “ About  two  weeks — no,  longer;  it  must  have  been 
five  or  six  weeks  ago.”  (Approximately  correct.)  Asked  what 
he  did  at  this  time  he  said,  “ Tapping,”  also  making  the  motion 
with  his  hand.  He  then  lapsed  into  his  former  inaccessibility, 
sitting  immobile,  with  head  hung  down,  and  nothing  further 
could  be  gotten  from  him. 

Clinical  notes  of  the  patient’s  condition  at  and  about  this  time 
are  as  follows : “ The  patient  has  a dull  facial  expression.  He 
sits  about  in  a dull,  apathetic  manner.  The  saliva  drools  from 
his  mouth,  and  he  remains  in  fixed  attitudes  for  long  periods  of 
time,  is  very  resistive,  and  does  not  dress  or  undress  himself, 
and  at  times  shows  considerable  negativism.  Occasionally  there 
are  times  during  which  he  is  active,  and  during  these  spells  he 
does  undress  himself  and  tears  his  clothing.”  This  covers  the 
patient’s  condition  during  September,  October,  and  November, 
1908.  During  December  he  is  reported  to  have  shown  consid- 
erable improvement.  “ There  is  at  present  considerable  retarda- 
tion of  both  psychical  and  physical  activities,  but  he  is  able  to 
answer  questions  fairly  well.  Memory  and  orientation  seem  to 
be  quite  good.  He  has  taken  on  considerable  flesh  of  late,  and 
is  gradually  becoming  more  active  and  doing  some  light  work 
about  the  ward.”  Three  months  later : “ The  patient  continues 
to  show  a slight,  gradual  improvement.  At  present  he  takes  con- 
siderable interest  in  his  surroundings,  reads  the  newspapers,  has 
parole,  and  does  considerable  work  about  the  ward.  Some 
retardation  exists  in  his  mental  and  physical  condition.”  And 
again,  a month  later,  “ The  patient  is  showing  gradual  improve- 
ment, is  at  present  doing  some  work  about  the  grounds,  but  is 
rather  slow  in  all  his  movements,  and  does  not  show  a normal 
amount  of  interest  in  his  surroundings.  There  is  some  retardation 
of  both  mental  and  physical  activities.” 

Since  this  time  the  patient  has  been  at  home,  where  he  was  seen  a 
few  days  before  the  present  writing,  but  the  data  obtained  still  leave  diag- 
nosis doubtful. 


FREDERIC  LYMAN  WELLS 


35 


1909] 

So  that,  as  between  manic-depressive  depression  and  dementia 
prsecox,  we  have  a previous  history  that  speaks  strongly  for 
dementia  prsecox,  a picture  at  the  time  of  the  experiments  that 
showed  traits  both  of  a manic-depressive  and  of  a prsecox  nature, 
and  a course  that  is  much  more  characteristic  of  a manic-de- 
pressive condition,  but  by  no  means  excludes  dementia  prsecox. 

.V 


24 

I 


The  overshadowing  characteristic  of  his  condition  at  the  times 
when  he  was  observed  was  the  slowness  and  inefficiency  of  his 
responses,  and  the  essential  point  is  whether  this  slowness  and 
inefficiency  represented  an  extreme  lack  of  affective  reaction,  or 
if  it  was  the  product  of  a specific  retardation  of  the  motor  func- 
tions. Regarding  this  question  the  curves  shown  in  Fig.  13  give 
some  rather  significant  testimony. 


36 


MOTOR  RETARDATION 


[July 


These  curves  stand  considerably  closer  to  what  has  been  ob- 
served in  manic-depressive  than  in  praecox  conditions.  The  gross 
rates  are  below  the  normal,  the  fs  are  high,  and  there  are  distinct 
phenomena  of  reversal,  these  being  in  each  case  more  prominent 
in  the  following  hand,  i.  e,,  the  left  in  the  first,  the  right  in  the 
second  experiment.  It  may  also  be  noted  that  in  the  first  ex- 
periment the  preceding  right  hand  is  much  poorer  than  the  left. 
In  the  second  experiment  the  following  right  hand  is  much  better 
than  the  left ; indeed,  the  transference  phenomenon  is  in  this  case 
more  striking  than  in  any  other  subject  observed,  save  in  the 
third  experiment  with  Case  II.  The  abnormalities  in  these  rec- 
ords are  distinctly  those  associated  with  manic-depressive 
depression  rather  than  with  dementia  praecox ; indeed,  it  is  quite 
doubtful  whether  dementia  praecox  cases  show  any  consistent 
abnormality  in  the  tapping  test.  In  the  presence  of  a specific 
motor  retardation  the  case  has  certainly  run  a very  different  course 
from  the  usual  dementia  praecox  cases,  in  whatever  diagnostic 
group  the  case  may  fundamentally  belong. 

Case  VII.  This  case  and  the  following  are  depressed  states 
showing  clinically  considerable  retardation,  but  with  factors  in 
the  history  indicating  the  possibility  of  one  of  the  protean  forms 
of  general  paralysis.  The  patient  was  a man  of  41,  veterinary 
surgeon,  no  heredity.  As  a boy,  he  showed  unusual  mental 
ability,  and  he  has  always  been  a hard  worker,  physically  strong, 
with  no  serious  illnesses  except  for  a history  of  syphilis.  There 
is  also  a history  of  some  nervous  breakdown  three  years  before 
admission,  from  which  it  is  not  certain  that  there  was  complete 
recovery,  but  which  did  not  interrupt  his  work.  The  symptoms 
definitely  related  to  the  present  illness  began  about  a month  before 
admission.  He  seemed  to  be  losing  interest  in  his  work,  would 
often  be  very  irritable,  and  quickly  get  over  it  again.  Appetite 
and  weight  were  falling  off.  There  were  no  known  fainting  at- 
tacks nor  seizures.  Physical  examination  was  negative,  though 
lumbar  puncture  showed  a marked  excess  of  small  lymphocytes. 
The  experiments  were  performed  about  four  months  after  admis- 
sion, and  the  patient  remained  under  observation  for  about  10 
months  after  this,  when  he  was  transferred,  his  condition  remain- 
ing practically  stable  up  to  the  present.  During  observation  he 


1909] 


FREDERIC  LYMAN  WELLS 


37 


was  fairly  clear,  his  memory  was  good.  No  great  emotional 
depression  was  evident  on  the  surface;  the  one  prominent  and 
fundamental  symptom  seemed  to  be  a marked  and  typical  retarda- 
tion. The  curves  are  as  below. 


The  curves  are  remarkably  inconstant  in  form.  The  second 
experiment  shows  much  less  fatigue  than  the  first,  and  the  left 
hand  much  less  than  the  right.  One  of  the  records  shows  con- 
siderable reversal,  but  the  individual  series  are  very  irregular, 
and  the  statistical  correspondences  with  the  certain  manic-depres- 


38 


MOTOR  RETARDATION 


[July 


sive  records  are  quite  likely  to  be  a product  of  chance.  There 
are  a good  many  failures  of  innervation,  as  long  periods  of  pres- 
sure and  release,  and  these  seem  to  be  more  marked  in  the  earlier 
portions  of  the  series.  The  performance  is  distinctly  a patholog- 
ical one,  but  it  is  more  similar  to  what  has  been  seen  in  coarse 
neurological  conditions,  and  it  seems  to  give  little  evidence  of  the 
clinically  apparent  retardation. 

Case  VIII.  A man  of  42,  merchant,  bad  heredity.  Was  bright 
and  active  as  a boy,  of  good  habits  and  learned  well.  He  went 
to  school  until  18,  since  when  he  has  been  in  business.  He  has 
applied  himself  very  closely  to  his  work,  hardly  ever  taking  a 
vacation,  was  not  thought  of  as  a nervous  man,  and  has  shown 
good  business  ability. 

The  present  attack,  which  is  the  first,  seems  to  date  back  to 
some  self-accusatory  ideas  which  the  patient  developed  regarding 
the  fatal  illness  of  a relative  to  whom  he  was  much  attached.  He 
began  to  sleep  poorly,  and  about  five  months  later  went  to  an 
institution,  where  he  was  mostly  unoccupied,  at  times  resisting 
the  efforts  of  the  nurses  to  get  him  out  of  doors,  though  he  was 
not  violent  nor  suicidal.  His  sleep  improved.  When  transferred 
to  the  McLean  Hospital  he  was  rather  depressed,  unoccupied, 
showed  no  interest,  not  speaking  spontaneously,  but  answering 
questions,  and  was  oriented.  He  remained  under  observation  a 
little  over  a year,  during  which  time  his  mental  condition  re- 
mained about  the  same,  perhaps  showing  a slight  improvement, 
and  again  a relapse  shortly  before  his  removal,  since  when  his 
condition  has  been  practically  stable.  The  present  tests  were  made 
a little  over  two  months  after  admission,  the  curves  being  as 
shown  in  Fig.  15. 

No  pathological  element  appears  in  these  records.  The  gross 
rate  is  somewhat  above  the  normal  average,  but  not  abnormally 
so,  and  the  same  is  true  of  the  susceptibility  to  fatigue.  There  are 
certain  characteristics  in  the  experiments  that  usually  appear  in 
normal  individuals  only  after  some  practice,  though  no  history 
of  such  practice  was  obtained.  Although  the  second  experiment 
is  slightly  inferior  to  the  first  (as  is  usually  the  case  with  normal 
individuals),  the  clinical  notes  indicate  a slight  improvement  in 
the  patient’s  condition  during  the  week  between  the  experiments. 
Whatever  may  be  the  correct  diagnosis  in  these  two  cases,  the 


FREDERIC  LYMAN  WELLS 


39 


1909] 


results  strongly  indicate  that  there  is  a type  of  retardation  in 
which  the  motor  work-curve  is  not  affected  in  the  same  way  as 
in  the  more  characteristic  retardation  of  manic-depressive  de- 
pression. 


\ 


Fig.  is. 


Case  IX.  It  is,  of  course,  a clinical  commonplace  that  retarda- 
tion is  not  a necessary  accompaniment  of  emotional  depression ; 
various  conditions  are  seen  in  which  the  depression  is  accompanied 
by  considerable  activity,  as  in  the  mixed  states  of  manic-depressive 
insanity  or  in  involution  melancholia.  From  this  point  of  view  the 


40 


MOTOR  RETARDATION 


[July 


records  of  three  agitated  depressions  may  be  presented  for  com- 
parative purposes.  The  first  of  these  is  a man  of  58,  bookkeeper, 
no  heredity.  He  learned  well  at  school,  and  after  a short  period 
as  a bank  clerk  became  a bookkeeper,  holding  a single  position  for 
the  30  years  preceding  his  illness.  It  seems  that  a year  or  two 
previous  to  this  attack  his  ability  had  been  falling  off,  but  the 
acute  symptoms  began  when  he  was  summarily  discharged  from 
the  position,  possibly  because  of  his  loss  of  efficiency.  Before 
admission  to  the  McLean  Hospital  he  had  been  18  months  in 
another  institution,  and  the  present  experiments  were  made  just 
one  year  after  admission.  Nearly  a year  has  elapsed  since  this 
time,  during  which  the  patient's  condition  has  not  changed  ma- 
terially. He  presents  uniformly  a typical  involution  picture,  show- 
ing anxiety,  agitation,  “ moral  pain  ” but  not  self-accusation, 
suicidal  tendencies,  and  a good  deal  of  motor  activity  and  rest- 
lessness. 

The  usual  experiment  was  made  10  times.  Co-operation  was 
exceptionally  good,  the  patient  often  seeming  to  go  at  the  test 
as  a temporary  substitution  that  might  distract  him  for  the 
moment  from  his  depressive  ideas.  During  the  pauses  he  would 
often  grow  impatient  to  begin  again.  Ten  experiments  were 
made,  on  successive  days,  the  right  hand  preceding  on  the  odd 
days,  the  left  hand  on  the  even  days.  The  curves,  calculated  in 
the  same  manner  as  for  Case  III,  p.  24,  are  as  shown  in  Fig.  16. 

The  gross  rate  is  somewhat,  not  markedly,  below  normal,  while 
the  / is  just  normal.  There  is  no  evidence  whatever  of  a motor 
retardation  in  the  shape  of  the  fatigue-curves.  If  the  records 
are  examined  with  reference  to  a transference  effect  from  one 
hand  to  another,  it  will  be  seen  that  each  hand  is  relatively  better 
when  it  precedes  than  when  it  follows.  This  is  seen  in  normal 
subjects,  but  the  phenomenon  in  this  case  is  much  more  marked ; 
it  is  the  precise  opposite  of  the  transference  that  is  seen  in  manic- 
depressive  retardation.  Its  character  is  illustrated  in  the  curves 
shown  in  Fig.  17,  which  are  plotted  in  the  same  manner  as  those 
for  Case  III. 

The  curves  of  total  efficiency  and  for  the  index  of  right-hand- 
edness run  in  precisely  opposite  directions  to  the  corresponding 
curves  in  Case  III,  who,  it  will  be  remembered,  was  a case 


1909] 


FREDERIC  LYMAN  WELLS 


41 


showing  a first  attack,  at  the  involution  period,  of  a typically 
manic-depressive  character.  In  the  present  case  the  curve  of  the 
right  hand  rises  on  the  odd  days,  when  it  precedes,  and  falls  on 
the  even  days,  when  it  follows ; while  the  curve  of  the  left  hand 
falls  on  the  odd  days,  when  it  follows,  and  rises  on  the  even  days, 
when  it  precedes.  The  index  of  right-handedness  shows  again 

3Z 

Z 

\ 


a precisely  opposite  alternation  from  that  of  Case  III,  but  the 
fatigue  phenomena  show  nothing  of  significance. 

It  will  be  remembered  that  in  Case  III  it  was  possible  to  trace 
a certain  correspondence  between  the  total  efficiency  curve  and 
the  fluctuations  in  the  patient’s  condition.  In  the  present  case  there 
were  fluctuations  in  the  patient’s  behavior  even  more  marked  than 
those  noted  in  Case  III,  but  they  have  left  absolutely  no  trace 
on  the  results.  These  fluctuations  consisted  in  a cyclic  exacerba- 
tion and  subsidence  of  the  agitated  symptoms  on  alternate  days. 


42 


MOTOR  RETARDATION 


[July 


Q.  Ag  Q.  O.  J^g  Af  OL  Aj  Q. 

iSo 


m 


Day  I 


S fc  T » 9 I* 

Fig.  17. 


"> 


4 


1909] 


FREDERIC  LYMAN  WELLS 


43 


This  may  be  illustrated  by  the  brief  daily  notes  of  the  patient’s 
attitude,  running  substantially  as  follows: 

October  12,  1908.  The  subject  entirely  co-operative.  Agitated 
and  depressed  but  quite  clear,  and  talks  a little  on  general  sub- 
jects, asking  for  example  about  the  possibility  of  the  Bulgarian 
tangle  resulting  in  a European  war. 

October  13.  Much  more  active  and  apprehensive  and  less  clear 
than  yesterday.  Talked  unceasingly,  begging  to  be  released. 
Complained  that  his  breathing  was  painful  and  that  his  bowels 
were  paralyzed.  Was  impatient  to  begin  every  fresh  series. 

October  14.  Not  so  agitated  as  yesterday  nor  so  calm  as  the 
day  before.  Did  not  ask  to  be  released.  Asked  questions  and 
made  remarks  spontaneously  on  various  subjects,  these  giving 
rather  the  idea  of  an  attempt  to  get  away  from  the  background 
of  the  depression. 

October  15.  Very  much  agitated,  with  continual  motor  activity. 
Begged  to  be  allowed  to  go  home,  offering  the  experimenter 
$10,000  to  recommend  his  discharge. 

October  16.  Very  quiet,  more  so  than  at  any  time  during  the 
experiments,  hardly  spoke  at  all,  except  to  himself. 

October  17.  Agitated,  a good  deal  of  motor  activity,  and  ap- 
parently more  “ moral  pain  ” than  at  previous  interviews. 

As  it  was  reported  that  this  alternation  of  quiet  and  agitated 
days  was  a regular  occurrence  with  the  patient,  no  experiment 
was  made  on  October  18  in  order  that  the  same  precedence  of 
the  hands  in  the  experiments  should  not  be  confined  to  depressed 
or  agitated  days. 

October  19.  Very  much  agitated,  more  active  than  at  any 
previous  time.  Paced  the  floor  continually,  offered  the  experi- 
menter $1000  an  hour  to  let  him  go  home  for  48  hours.  Also 
tried  to  induce  the  nurse  to  aid  in  his  escape. 

October  20.  Quiet,  did  not  get  up  out  of  chair.  Not  nearly 
so  agitated,  and  showed  more  ability  to  rise  above  the  depression. 

October  21.  After  the  second  series  paced  the  floor  contin- 
ually, twice  tried  to  get  into  a drawer  where  sharp  instruments 
were  kept,  and  made  requests  similar  to  those  above  noted  about 
going  home. 

October  22.  Patient  quiet.  Condition  substantially  similar  to 
October  20. 


44 


MOTOR  RETARDATION 


[July 


The  tapping  test  is  ordinarily  quite  responsive  to  such  changes 
in  condition  as  are  reflected  in  the  behavior  here,  and  its  failure 
to  be  aflPected  by  them  in  this  case  is  surprising.  It  may  be  men- 
tioned that  while  the  patient  actually  does  considerably  better  with 
his  left  hand,  he  said  that  it  was  easier  for  him  to  perform  with 
his  right,  and  he  also  said  he  thought  he  did  better  with  it. 
Though  the  difference  is  slight,  the  preferred  hand  shows  in  the 


long  run  the  greater  immunity  to  fatigue,  as  we  are  accustomed 
to  find. 

Case  X.  A man  aged  78,  retired  merchant,  some  heredity, 
early  history  negative.  He  was  successful  in  business,  from 
which  he  retired  at  63  on  account  of  “ nervous  prostration.”  For 
about  five  years  before  admission  he  was  somewhat  eccentric  and 
inclined  to  be  ugly  toward  his  family,  but  about  a month  before 
admission  his  attitude  changed  and  he  became  very  affectionate. 
This  lasted  -for  about  three  weeks,  when  one  night  he  performed 
a number  of  eccentric  actions,  finally  culminating  in  a feeble 


I909I  FREDERIC  LYMAN  WELLS  45 

attempt  to  kill  his  wife.  When  it  was  suggested  that  he  should 
come  to  the  hospital  he  was  at  first  willing,  but  later  became 
irritated  and  uncontrollable,  and  escaped  from  the  house  to  a 
pond  where  he  made  a weak  attempt  to  drown  himself.  Here 
he  presents  a picture  of  irritability,  a few  feeble  persecutory 
delusions,  and  a tendency  to  malingering,  but  with  alertness  and 
no  marked  memory  defect.  Two  experiments  were  performed 
about  six  weeks  after  admission,  the  results  being  as  shown  in 
Fig.  18. 

The  gross  rates  are  distinctly  above  the  normal  and  there  is 
neither  reversal  nor  favoring  of  the  following  hand.  The  right 
hand  fatigues  very  little,  but  there  is  partial  disability  in  the  right 
arm,  due  to  its  once  having  been  broken,  so  that  what  we  have 
here  may  be  analogous  to  the  latter  part  of  the  fatigue-curve,  the 
higher  initial  rate  that  we  should  have  had  being  lost.  The  left 
hand  begins  at  about  the  same  level  as  the  right  and  fatigues 
normally.  These  records  thus  show  no  evidence  of  a motor 
retardation. 

Case  XL  A printer,  aged  47,  bad  heredity ; has  used  a great 
deal  of  alcohol.  The  present  attack  is  the  seventh.  Between  the 
previous  attacks  he  has  cleared  up  sufficiently  to  work,  but  his 
intemperate  habits  doubtless  help  to  throw  him  into  the  successive 
depressions.  The  present  condition  is  characterized  by  consid- 
erable emotional  depression  with  delusions.  He  is  always  on  the 
move,  though  his  movements  are  not  especially  rapid  or  efficient. 
He  does  not  speak,  but  keeps  up  a low  moaning  to  himself.  How- 
ever, he  understood  what  was  wanted  in  the  experiments  with 
surprisingly  little  difficulty,  and  co-operated  exceptionally  well, 
seeming,  like  Case  IX,  to  go  at  the  test  as  a sort  of  ‘‘  substitution.” 
In  the  ward  he  wore  mitts  to  keep  him  from  tearing  his  clothing, 
which  were  necessarily  removed  for  the  experiments,  and  the 
entire  time  of  the  pauses  he  would  spend  picking  at  himself  unless 
restrained.  Two  experiments  were  performed,  the  second  two 
days  after  the  first,  the  fatigue-curves  being  as  shown  in  Fig.  19. 

Only  one  of  these  curves,  that  of  the  right  hand  in  the  first 
experiment,  shows  an  abnormal  immunity  to  fatigue,  nor  is  there 
sufficient  evidence  of  transference  to  afford  any  certain  criteria 
of  motor  retardation  in  these  records. 


46 


MOTOR  RETARDATION 


[July 


The  method  then  fails  to  demonstrate  in  these  three  cases  the 
usual  phenomena  of  retardation,  in  spite  of  the  fact  that  the  last 
considered  case  should  probably  be  assigned  to  the  manic-depres- 
sive  group  in  any  but  the  narrowest  acceptation  of  the  term. 

T. 

\ 

\ 

\ 

\ 

3 3^  \ 


Fig.  19. 


3.  General  Conclusions. 

In  order  to  compare  the  average  performance  in  the  tapping 
test  of  normal  and  depressed  individuals,  as  well  as  the  perform- 
ance in  diagnostic  groups  in  whose  symptomatology  retardation 


1909] 


FREDERIC  LYMAN  WELLS 


47 


does  not  play  a fundamental  part,  the  accompanying  figure  is 
presented.  This  gives  the  average  fatigue-curve  in  10  normal 
subjects,  seven  manic  subjects,  six  cases  of  dementia  prsecox,  five 
of  general  paralysis,  and,  finally,  that  of  the  10  manic-depressive 
cases  presented  in  a previous  study.  While  the  individual  cases, 
of  course,  vary  considerably  about  these  averages,  it  is  doubtful 


/o"  IS"  2.0"  zs"  3o‘ 

Fig.  20. 

if  the  significance  of  the  results  warrants  their  more  detailed 
presentation  in  this  connection.  The  principal  point  in  this  figure 
concerns  the  relation  of  the  manic  performance  to  the  depressed. 

The  results  of  the  manic  cases  indicate  a maximum  rate  dis- 
tinctly above  the  normal.  In  the  cases  which  showed  a real 
manic  excitement  the  maximum  rate  was  considerably  higher,  but 
the  average  is  brought  down  by  two  cases  who  showed  a rather 


48 


MOTOR  RETARDATION 


[July 


easy-going  euphoria,  and  co-operated  with  more  willingness  than 
zeal.  The  curve  remains  somewhat  above  the  performance  of 
normal  subjects  until  half  way  through  the  work  period,  when  it 
drops  somewhat  below  it.  Compared  with  the  normal  cases, 
the  manic  thus  show  a higher  initial  rate  and  a greater  suscepti- 
bility to  fatigue.  In  the  isolated  cases  in  which  it  was  possible 
to  observe  the  behavior  of  the  test  with  respect  to  changes  in 
condition,  it  seemed  also  that  the  more  manic  states  had  the  higher 
initial  rate  with  the  greater  susceptibility  to  fatigue. 

The  average  curve  of  the  depressed  states,  on  the  other  hand, 
shows  a very  slow  initial  rate  with  a slight  reversal  in  the  first 
interval,  which  then  fatigues  very  gradually  through  the  rest  of 
the  work  period.  The  work-curves  of  the  manic  and  depressed 
states  are  thus  found  to  be  both  in  amount  and  character  on 
opposite  sides  of  the  normal. 

Franz,  using  two  normal,  two  depressed,  and  two  manic  sub- 
jects in  various  psychological  tests,  did  not  find  any  consistent 
superiority  of  the  manic  performance  over  the  normal ; indeed, 
the  manic  subjects  were  apt  to  be  rather  inferior  to  the  normal, 
though  not  so  much  so  as  the  depressions.  Hutt,  however,  using 
the  fatigue-curve  of  the  addition  test  again  found  the  manic 
performance  to  be  somewhat  superior  to  the  normal.  On  the 
other  hand,  while  there  is  in  the  tapping  test  observed  an  increased 
susceptibility  to  fatigue,  Hutt  found  that  manic  cases  would  grad- 
ually increase  in  rapidity  in  the  same  manner  as  the  depressions. 
There  are  features  in  the  manic  state  according  to  which  either 
of  these  results  can  be  interpreted.  Hutt  classes  the  increased 
manic  efficiency  with  the  increased  excitability  under  stimulation 
clinically  noted  in  these  cases ; the  abnormally  rapid  loss  in  effi- 
ciency found  in  the  present  experiments  corresponds  rather  to  the 
suspended  inhibition  of  manic  cases,  leading  to  the  putting  forth 
of  greater  initial  effort,  and  consequently  the  more  rapid  wearing 
out  of  the  organism.  The  explanation  of  the  difference  probably 
rests  in  the  character  of  the  experimental  task,  and  the  different 
levels  of  neural  activity  which  are  involved.  Objective  motor 
fatigue  is  generally  admitted,  while  the  nature  or  even  the  exist- 
ence of  intellectual  fatigue  is  still  somewhat  in  dispute. 

Working  with  the  eye  movements  over  a wide  range  of  cases. 


1909] 


FREDERIC  LYMAN  WELLS 


49 


Diefendorf  and  Dodge'  found  the  angular  velocity  in  manic  cases 
distinctly  superior  to  the  normal.  On  the  other  hand,  the  simple 
reaction  time,  as  well  as  the  pursuit  reaction,  was  found  to  be 
slightly  shorter  in  the  normal  than  in  the  manic  cases.  It  may 
be  noted,  however,  that  in  these  two  functions  the  greater  dis- 
tractibility  and  inferior  attention  of  the  manic  cases  would  operate 
more  to  their  disadvantage.  This  perhaps  explains  why,  though 
the  manic  states  are  worse,  the  “ hypomanic are  better  than  the 
normal  in  these  two  functions ; the  distractibility  would  be  less 
here  and  the  attention  better.  They  are,  however,  not  quite  so 
quick  in  simple  reaction. 

It  is  the  prevalent  clinical  opinion  that  the  greater  superficial 
activity  in  the  manic  state  is  to  be  interpreted  not  as  the  greater 
efficiency  of  the  nervous  impulse  but  as  the  removal  of  the 
inhibitions  it  ordinarily  has  to  overcome.  This  fact  does  not 
itself  justify  the  secondary  interpretation  sometimes  made  that 
psychic  capacity  is  fundamentally  decreased  in  the  manic  state 
just  as  truly  as  in  the  depressed.  Every  clinician  of  experience 
is  familiar  with  cases  who  make  much  better  superficial  impres- 
sions, and  who  in  some  instances  may  be  actually  regarded  as 
more  efficient  members  of  society  when  they  are  hypomanic  than 
when  they  are  normal.  The  potentiality  of  the  more  efficient  re- 
actions is  there,  but  they  are  normally  restrained  by  inhibitions 
which  the  hypomanic  condition  removes.  Thus  the  taciturn  indi- 
vidual who  becomes  an  excellent  conversationalist  after  a few 
glasses  of  wine  may  have  the  same  ideas  when  normal  as  when 
elevated,  but  in  the  normal  state  their  expression  is  inhibited 
by  something  that  he  would  probably  describe  as  the  thought  that 
the  ideas  were  too  trivial  to  express. 

If  the  essence  of  the  manic  state  is  the  removal  of  inhibitions, 
it  follows  as  a corollary  that  maximum  efforts  must  be  higher  in 
the  manic  state  than  in  the  normal  state.  Maximum  efforts  may 
not  be  so  easy  to  obtain,  owing  to  distractibility,  nor  may  the  re- 
actions be  so  well  adjusted  to  the  environment,  owing  to  clouded 
judgment.  But  the  inferiority  that  manic  cases  are  very  apt  to 
show  in  psychological  tests  demanding  special  co-oj>erative  effort 
is  probably  mainly  secondary  to  the  first  of  these  factors.  If  as 

’ Brain,  Vol.  XXXI,  Part  CXXIII,  1908,  pp.  451-489. 


4 


50 


MOTOR  RETARDATION 


[July 

good  ‘‘  attention  ” or  concentration  could  be  obtained  as  with 
the  normal  state,  the  maximum  performance  should  be  better. 

It  must  probably  be  regarded  as  a limitation  of  the  German 
terminology  that  it  uses  the  word  Hemmung  to  describe  both 
retardation  and  inhibition.  Hoch  has  indicated  this  difficulty  very 
clearly®  in  his  studies  of  retardation,  especially  in  his  employment 
of  the  term  resistances  instead  of  inhibitions  to  describe  the  proc- 
ess. That  psychomotor  retardation  is  the  product  of  excessive 
inhibition  is  more  than  doubtful.  Inhibition  is  opposition,  and 
excessive  inhibition  is  nothing  more  nor  less  than  a blocking 
negativism,  which  is  not  part  of  the  recognized  symptomatology 
of  manic-depressive  insanity.  This  is  a difficulty  that  must  be 
overcome  if  the  strict  continuity  of  the  manic  and  depressed  states 
is  to  be  maintained  together  with  the  theory  of  decreased  inhibi- 
tion in  the  manic  states.  We  must  recognize  two  factors  that  may 
lessen  the  freedom  of  a mental  or  motor  reaction — opposition  and 
obstruction.  Excess  of  the  former  is  negativism,  excess  of  the 
latter  is  retardation.  The  crucial  question  then  becomes:  Is  the 
manic  state  a removal  of  inhibitions  or  a removal  of  obstructions  ? 
Removal  of  inhibitions  describes  the  manic  state  as  we  know  it 
very  well,  but  excessive  inhibitions  describes  something  very  dif- 
ferent from  the  retarded  state.  On  the  other  hand,  excess  of  ob- 
structions describes  the  retarded  state  very  well,  while  its  relation 
to  the  manic  state  is  the  same  as  that  of  the  theory  of  loss  of 
inhibition.  Both  viewpoints  are  compelled  to  conceive  of  some 
process  which  acts  independently  upon  the  primary  or  the  inhibi- 
tory impulses,  for  if  they  were  equally  affected  the  end-effects 
would  remain  essentially  unchanged.  The  point  is  perhaps  a minor 
one,  but  for  the  sake  of  clearness  it  might  be  well  to  examine  the 
objective  criteria  of  obstruction,  or  resistances,  as  distinguished 
from  inhibitions,  with  reference  to  the  more  precise  analysis  of 
the  manic  state. 

Such  phenomena  of  retardation  as  appear  in  the  dementia 
praecox  cases  observed  are  objectively  differentiated  from  the 
depressive  ones  in  that  they  appear  more  episodically,  almost 
fortuitously,  as  it  were,  affecting  one  hand  and  not  the  other, 
or  only  individual  series  with  a single  hand,  as  distinguished  from 

■Hoch:  On  Certain  Studies  with  the  Ergograph.  Journ.  Nerv.  and 
Ment  Diseases,  XXVIII,  1901,  p.  626. 


1909] 


FREDERIC  LYMAN  WELLS 


51 


the  manic-depressive  retardation  whose  manifestations  are  more 
consistent  throughout.  However,  while  there  have  not  been  ob- 
served outside  the  depressed  states  instances  of  the  phenomena 
of  retardation  which  did  not  seem  to  have  objectively  a different 
origin  from  those  regularly  observed  within  the  depressed  states, 
yet  the  possibility  must  be  granted  that  the  retardation  measured 
in  these  experiments  may  be  a symptom  of  many  mental  diseases, 
possibly  in  much  the  same  way  as  a rise  in  temperature  is  a 
frequent  accompaniment  of  bodily  disorders.  We  do  not  discard 
the  clinical  thermometer  because  it  will  not  immediately  dis- 
tinguish between  the  fever  of  a typhoid  and  the  fever  of  a pneu- 
monia ; nor  need  the  measurement  of  retardation  lose  its  clinical 
significance  because  it  will  not  serve  the  purposes  of  penny-in- 
the-slot  diagnosis. 

To  briefly  recapitulate.  The  measurement  of  such  elementary 
functions  as  are  given  in  the  ocular  reaction  times,  the  ocular 
pursuit  movements,  or  the  tapping  test  and  the  like,  affords  the 
most  unequivocal  criterion  of  motor  retardation  that  it  is  at  present 
practicable  to  obtain.  The  criteria  of  motor  retardation  as  illus- 
trated by  the  tapping  test  are  (a)  a lowered  absolute  rate,  (b)  a 
rise  in  the  work-curve  where  it  should  normally  fall  (reversal), 
(c)  a relative  gain  over  the  normal  in  the  efficiency  of  the  work 
that  comes  later  in  the  experiments  (transference).  Case  I,  su- 
perficially characterized  mainly  by  fixed  ideas,  illustrated  marked 
phenomena  of  retardation  under  the  conditions  of  the  experiment, 
indicating  the  existence  of  a more  fundamental  psychic  disturb- 
ance to  which  the  fixed  ideas  are  secondary.  Later,  this  case 
showed  extreme  instability  of  the  phenomena  of  retardation, 
which  markedly  decreased  through  the  experiments,  a progressive 
change  which  the  mood  tended  to  parallel.  Case  II  illustrated  a 
pronounced  motor  retardation,  probably  without  much  thinking 
disorder.  Here  there  were  also  to  be  noted  characteristic  fluctua- 
tions as  the  experimental  work  progressed.  Case  HI  was  mainly 
significant  in  showing  that  the  phenomena  of  retardation  might 
appear  characteristically  in  a first  attack  at  the  involution  period, 
in  giving  an  especially  clear-cut  illustration  of  transference  phe- 
nomena and  further  reflecting  episodic  changes  in  condition. 

Case  IV  illustrates  the  effect  of  an  objectively  given  condition 
of  retardation  in  accentuating  the  phenomena  of  transference  and 


52 


MOTOR  RETARDATION 


[July 

lowered  absolute  rate.  Case  V illustrated  certain  phenomena  in 
retardation  in  a depression  of  immediate  traumatic  antecedents, 
and  with  other  clinical  characters  of  the  traumatic  psychosis. 
In  Case  VI  the  characteristic  phenomena  of  manic-depressive 
retardation  appeared  in  a case  showing  otherwise  many  dementia 
praecox  traits,  but  whose  subsequent  course  was  more  favorable 
than  is  usually  to  be  anticipated  in  this  condition.  In  Cases  VII 
and  VIII  a considerable  clinical  retardation  failed  to  reveal  itself 
in  any  characteristic  way  experimentally ; in  each  of  these  cases  the 
possibility  of  a general  paralysis  had  been  considered.  Case  IX 
is  a classical  involution  depression  whose  deviations  from  the 
normal  are  in  the  opposite  direction  from  those  of  the  manic- 
depressive  depressions.  No  retardation  is  shown  and,  save  for 
the  lowering  of  the  gross  rate,  the  performance  resembles  that 
of  the  manic  cases  more  than  that  of  the  typical  manic-depressive 
depressions.  The  performance  is  also  practically  unaffected  by 
considerable  fluctuations  in  the  superficial  condition.  Cases  X 
and  XI  are  presented  in  this  same  connection,  as  agitated  de- 
pressions not  showing  retardation ; and  affording,  with  the  three 
previous  cases,  experimental  indication  that  emotional  depression 
involves  retardation  no  more  necessarily  than  retardation  involves 
emotional  depression.  Each  is  seen  fundamentally  and  inde- 
pendent of  the  other,  though  either  may  be  secondary  to  the  other. 

The  cases  of  dementia  praecox  and  general  paralysis  show 
little  or  nothing  of  significance,  but  the  manic  cases  tend  to 
show  an  increased  initial  rate  and  a heightened  susceptibility  to 
fatigue,  the  exact  reverse  of  what  is  shown  by  the  retarded  cases. 
When  the  psychological  measure  can  be  made  sufficiently  inde- 
pendent of  special  factors  in  co-operation  it  is  probable  that  the 
optimum  performance  of  manic  states  is  quite  superior  to  the 
normal  as  well  as  the  depressed.  Insufficient  light  exists  on  this 
question,  however,  a satisfactory  treatment  of  which  is  possible 
only  in  the  study  of  a group  of  circular  cases  through  various 
'periods  of  depression  and  excitement.  Since  the  essentially  re- 
tarded state  is  almost  certainly  an  over-obstruction,  not  an  over- 
inhibition, of  the  reaction,  the  manic  state  may  also  perhaps  be 
better  interpreted  as  the  loss  of  normal  and  teleological  obstruc- 
tion to  the  primary  impulses  rather  than  to  the  loss  of  an  inhibitory 
faculty  usually  exercised  by  the  opposite  impulses. 


